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A  PRACTICAL  TREATISE 


ON  THE  CAUSES,  SYMPTOMS  AND  TREATMENT 


SPERIATORRHCEA: 


BY 

M.   LALLEMAND, 

FORMERLY  PROFESSOR  OF  CLINICAL  SURGERY  AT  THE  UNIVERSITY  OF  MONTPELLIER,  ETC. 

HBNEY   J.  McDOUGALL, 

MEMBER  OF  THE  ROYAL  COLLEGE  OF  SURGEONS  OF  ENGLAND,  ETC.  ETC. 


FOURTH   AMERICAN    EDITION. 

TO  WHICH  IS  ADDED, 

0^  DISEASES  OF  THE  YESICUL^  SEMINALES 

AND  THEIR  ASSOCIATED  ORGANS: 

WITH  SPECIAL  REFERENCE  TO  THE 

MORBID  SECRETIONS  OF  THE  PROSTATIC  AND  URETHRAL  MUCOUS  MEMBRANE. 


HARRIS    WILSON,  M.D. 


PHILADELPHIA: 

BLANCHAED    AND    LEA. 
1861. 


PHILADELPHIA : 
COLLIJfS,  PEINTEK,  705  JAYNE  STKEET. 


AMERICAN 
PUBLISHERS^    NOTICE 


A  considerable  period  having  elapsed  since  the  publica- 
tion of  the  work  of  M.  Lallemand,  the  publishers  have 
thought  that  the  value  of  the  present  edition  might  be  en- 
hanced by  the  addition  of  the  little  treatise  of  Dr.  Marris 
Wilson,  which,  since  its  recent  appearance  in  London,  has 
already  acquired  a  high  professional  character.  The  reader 
will  thus  have  the  advantage  of  comparing  the  views  ad- 
vanced by  M.  Lallemand,  with  the  latest  results  of  profes- 
sional experience,  embodying  the  present  state  of  the  sub- 
ject investigated  with  the  aid  of  modern  pathology. 

Philadelphia,  July,  1858. 


AUTHOR'S    PEEFACE. 


During  a  period  of  fourteen  years,  I  have  collected  more  than  one 
hundred  and  fifty  cases  in  which  involuntary  seminal  discharges 
■were  sufficiently  serious  to  disorder  the  health  of  the  patients  con- 
siderably, and  even  sometimes  to  cause  death. 

Most  of  these  patients  have  been  sent  to  me  on  account  of  sus- 
pected cerebral  affections  of  more  or  less  standing.  Hence,  by  a 
singular  chance,  it  has  been  in  consequence  of  the  publication  of  my 
'•'•  Recherches  Anatomico-PatJiologiques^  sur  Vencepkale  et  ces  depen- 
dances,"  that  I  have  obtained  the  most  remarkable  cases  of  diurnal 
pollutions  ;  and  I  have  correctly  refused  to  acknowledge  the  presence 
of  disease  of  the  brain  or  its  membranes  in  many  cases  where  the 
existence  of  such  disease  had  previously  been  considered  indisputa- 
able. 

Many  other  of  these  patients  were  supposed  to  suffer  from  chronic 
gastritis,  or  gastro-enteritis ;  from  aneurisms  near  the  heart,  the 
early  symptoms  of  phthisis,  &c.  &c. ;  and  in  other  cases  from  nerv- 
ous affections,  and  especially  from  hypochondriasis. 

These  few  words  show  how  frequent,  important,  and  difficult  of 
detection,  are  involuntary  seminal  discharges,  and  to  what  deplorable 
errors  of  treatment  they  daily  give  rise  :  it  may  be  foreseen,  too,  that 
their  causes  must  be  very  varied,  and  their  treatment  present  con- 
siderable difficulties. 

The  Brochure  of  Wickmann  and  the  commentaries  on  it  by  Sainte- 
Maria,'  are  the  only  writings  we  possess,  on  a  disease  that  degrades 
man,  poisons  the  happiness  of  his  best  days,  and  ravages  society  ! 
Of  the  researches  of  these  conscientious  observers,  too,  the  profession 
are  almost  ignorant. 

They  have,  nevertheless,  done  all  in  their  power  to  call  the  atten- 


'  Dissertation  sur  la  pollutioa  diurne  involuntaire ;  par  Wickmann ;  traduction  de 
Sainte-Maria. — Lyons,  1817, 


yi  PKEFACE. 

tion  of  practitioners  to  a  subject  of  which  they  fully  felt  the  impor- 
tance, and  they  have  stated  many  valuable  truths.  Why  is  it,  then, 
that  a  more  lasting  impression  has  not  been  made  on  the  medical 
world  ?  Doubtless  because  they  have  not  supported  their  statements 
by  a  sufficient  number  of  well  detailed  cases,  and  especially  because 
those  related  are  vaguely  and  generally  stated. 

Althouf^h  "Wickmann  and  Sainto-Maria  have  stated  facts  which 
have  not  been  appreciated,  they  have  left  numerous  omissions  to  be 
supplied,  and  more  than  one  serious  error  to  be  corrected. 

The  materials  I  possess  permit  me  to  hope  that  I  shall  be  more 
successful ;  at  all  events,  I  consider  it  my  duty  to  publish  them. 


EDITOR^S  PUEFACE. 


Ix  la^'ing  the  following  condensed  edition  of  M.  Lallernand's  im- 
portant work  on  Involuntary  Seminal  Discharges  before  my  pro- 
fessional brethren  in  an  English  dress,  I  have  been  actuated  by  the 
conviction  that  the  disorder  treated  of  is  little  understood  by  the 
profession  generally  in  this  country.  The  patients  affected  by  it  are 
always  hypochondriacal — indeed,  the  symptoms  of  hypochondriasis 
and  mental  derangement  are  generally  by  far  the  most  prominently 
marked  in  them — and  after  the  usual  remedies  for  digestive  disorder 
and  liver  disease  have  been  had  recourse  to  without  benefit,  the  prac- 
titioner becomes  tired  of  attending  a  disease  which  is  at  best  obscure 
and  does  not  yield  to  the  usual  remedies,  and  either  treats  his  patient 
as  a  malacle  vnaginaire,  or  leaves  him  a  prey  to  the  wretched  balsam- 
selling  quacks,  who  are  unfortunately  permitted  to  pollute  every  pe- 
riodical publication  with  their  disgusting  advertisements. 

The  subject  of  Spermatorrhoea  is  an  uninviting  one — especially  to 
the  fastidious — perhaps  too  fastidious  English  taste  ; — hence,  with 
very  few  exceptions,  it  has  been  generally  avoided  by  regularly  edu- 
cated practitioners  in  this  country.  An  abstract  of  M.  Lallemand's 
views  was  indeed  published  by  my  friend,  Mr.  Phillips,  in  the  Medi- 
cal Gazette  in  the  year  1843,  and  about  the  same  time  some  papers 
appeared  in  the  Lancet  on  the  same  subject  by  Drs.  Ranking  and 
Dangerfield,  and  Messrs.  Ryan,  Chatto,  and  Dudgeon.  These  pub- 
lications, however,  from  their  transitory  nature,  were  not  calculated 
to  remedy  the  want  felt  by  the  profession,  of  a  systematic  treatise  on 
this  important  subject.  Mr.  Phillips,  indeed,  in  the  conclusion  of  his 
paper  in  the  Medical  Gazette,  takes  occasion  to  remark :  "  Since  the 
publication  of  the  first  part  of  this  paper,  I  have  been  painfully  im- 
pressed with  the  conviction,  that  the  evil  is  more  widely  spread  than 
I  had  before  conceived  ;  and  that  it  will  not  be  largely  alleviated  by 
the  means  I  have  adopted  for  advocating  the  relief  of  a  particular 

remedy The  pages  of  a  strictly  Medical  Journal  do  not  meet 

the  eyes  of  the  great  mass  of  sufferers." 

In  a  notice  also  of  M.  Lallemand's  work,  in  the  British  and  Foreign 
Medical  Review,  the  reviewer  took  an  opportunity  of  pointing  out  the 
importance  of  the  subject.  Nevertheless,  authors  have  always  seemed 
to  avoid  the  subject  as  dangerous  ground,  and  with  the  exception  of 


viii  PEEFACE. 

an  excellent  chapter  in  Mr.  Curling's  work  on  Diseases  of  the  Testis, 
aacl  some  observations  published  by  Dr.  Smyth  in  a  work  entitled 
"  Miscellaneous  Contributions  to  Pathology  and  Therapeutics,"  I 
believe  the  present  to  be  the  first  attempt  to  render  the  profession 
familiar  with  this  disorder,  by  any  special  work  in  the  English  lan- 
guage. 

Indeed,  in  Dr.  Golding  Bird's  otherwise  excellent  book  on  urinary 
deposits,  the  author,  although  he  admits  that  the  spermatozoa  are  fre- 
quently discovered  in  the  urine  by  microscopic  examination,  takes 
occasion  to  express  his  opinion,  that  the  subject  of  spermatorrhoea  is 
one  by  no  means  deserving  the  importance  attached  to  it.  He  adds, 
"  It  certainly  is  not  very  consistent  with  our  national  character,  to 
dilate  so  freely  on  a  subject  which,  in  the  great  majority  of  cases,  can 
be  treated  of  only  as  the  eflFects  of  a  most  degrading  vice."  That 
any  physician  should  relieve  himself  from  the  investigation  of  a  most 
afflicting  disease,  because  the  subject  treated  of  is  an  unpleasant  one, 
appears  to  me  unworthy  the  general  character  of  our  profession. 
Had  similar  opinions  been  held  respecting  syphilis — a  subject  quite 
as  repugnant  to  English  feelings  as  spermatorrhoea — what  misery 
would  have  been  entailed  on  the  human  race  ? 

Lecturers  on  surgery,  while  entering  fully  on  other  diseases  of  the 
urethra,  appear  either  not  to  have  been  aware  of,  or  by  common  con- 
sent to  have  omitted,  spermatorrhoea  from  their  oral  lectures  and  text- 
books of  surgery.  Professor  Miller,  of  Edinburgh,  having  given  a 
short  notice  of  spermatorrhoea  in  his  "  Practical  Surgery,"  published 
in  1846,  is,  as  far  as  I  am  aware,  the  only  exception  to  this  rule. 

At  an  early  part  of  my  professional  life  my  attention  was  much 
engaged  by  two  cases,  which  to  me  presented  peculiar  features  of 
interest.  One,  the  case  of  a  near  relative  since  dead,  proved  par- 
ticularly unfortunate.  The  other,  the  case  of  a  friend  of  about  my  own 
age — also  studying  medicine —  recovered  after  several  relapses  ;  and 
the  patient  is  at  present  practising  his  profession  in  her  Majesty's 
service.  In  both  cases  the  best  advice  the  West  of  England  afforded 
was  obtained  without  success,  or,  indeed,  even  slight  improvement, 
and  in  neither  case  was  the  cause  of  the  disorder,  which  particularly 
affected  the  brain  and  digestive  organs,  recognized. 

The  interest  I  took  in  these  cases  led  me  to  suspect,  from  certain 
hints  thrown  out  by  the  patients,  that  their  disorders  were  somehow 
connected  with  the  genital  organs.  Further  experience  has  con- 
vinced me  that  my  suspicions  were  correct. 

A  brief  outline  of  these  cases  may  not  be  uninteresting. 

E.  H ,  ^t.  thirty-nine,  passed  the  early  part  of  his  life  in  the 

country,  and  was  in  the  habit  of  taking  much  and  violent  exercise. 
About  the  age  of  sixteen,  he  entered  a  banking  establishment  in  Lon- 
don, in  which  by  great  diligence  and  steadiness  of  conduct  he  rose, 
before  he  was  twenty-five,  to  the  post  of  cashier.  The  affairs  of  the 
house  fell  into  disorder,  and  ultimately  a  bankruptcy  occurred  ;  Mr. 
H ,  from  the  amount  of  confidence  reposed  in  him    by  the 


PREFACE.  ix 

partners  of  the  firm,  -was  much  harassed  during  these  unfortunate  pro- 
ceedings. Soon  afterwards  he  became  manager  of  a  large  mercan- 
tile establishment  in  the  city,  and  about  this  time  commenced  some 
speculations  in  foreign  bonds.  From  fluctuations  in  the  share  market 
he  was  a  loser  to  a  considerable  extent ;  his  mind  was  much  harassed, 
and  he  began  to  suspect  those  about  him  of  dishonesty  towards  their 
employers.  On  investigation  these  suspicions  were  proved  to  be 
totally  unfounded ;  Mr.  H gave  way  to  great  violence  of  con- 
duct, and  resigned  his  situation.     About  this  time  his  father  died  ; 

and  Mr.  H was  much  disappointed    at  finding  that  property, 

which  he  had  incorrectly  believed  entailed,  and  consequently  his,  as 
eldest  son,  was  left  by  will  to  be  equally  divided  between  himself  and 
the  rest  of  his  family.  His  conduct  at  this  period  was  of  the  strangest 
description.  He  dreaded  to  go  out  into  the  streets  of  the  town  where 
his  family  resided,  refused  to  join  in  their  meals,  and  ultimately  ab- 
ruptly left  their  house  to  return  to  London.  In  1837  his  state  had  be- 
come such  that  in  consequence  of  his  repeated  letters,  members  of  his 
family  visited  London,  and  on  their  return  took  him  with  them  into 
Devonshire.  About  this  time  his  mental  disorder  put  on  a  decided 
aspect ;  and  I  had  then,  as  well  as  later,  ample  opportunities  of  ob- 
serving his  conduct;  and  frequently  heard  his  complaints.  Emissa- 
ries were  constantly  on  the  search  for  him  to  arrest  him  for  unnatural 
crimes  committed  in  London ;  every  one  who  met  him  in  the  street 
read  in  his  countenance  the  crimes  he  had  committed  ;  tailors  made 
his  coats  with  the  sleeves  the  wrong  way  of  the  cloth,  in  order  to 
brand  him  with  infamy  ;  the  sight  of  a  policeman  in  the  street  alarmed 
him  beyond  measure  ;  and  often,  if  a  stranger  happened  to  be  walking 
for  some  little  time  in  the  same  direction  as  himself,  he  would  ex- 
claim that  he  was  one  of  the  emissaries  sent  to  seize  him.  At  other 
times  he  would  lock  himself  in  his  room  and  weep  by  the  hour.  He 
never  took  his  meals  with  the  family,  and  never  tasted  food  or  drink 
without  first  preserving  a  portion  for  chemical  analysis,  as  he  was  con- 
vinced his  friends  were  in  a  conspiracy  to  poison  him  slowly,  in  order 
to  wipe  out  the  memory  of  his  crimes.  These  ideas  haunted  him 
night  and  day.  His  digestion  was  much  disordered  ;  his  sleep  broken 
and  restless,  and  his  bowels  excessively  constipated.  His  face  was 
flushed,  and  periodical  attacks  of  cerebral  excitement  occurred,  during 
which  he  complained  of  vertigo,  noise  in  the  head,  loss  of  sight,  &c. 
He  complained  also  of  loss  of  memory,  and  frequently  of  bodily  weak- 
ness and  lassitude.  The  best  medical  advice  the  neighborhood 
afforded  was  obtained,  unavailingly ;  the  opinions  of  the  gentlemen 

consulted  were,  that    Mr.  H was    laboring  under  aggravated 

hypochondriasis,  complicated  with  monomania.  Various  causes  were 
suggested  as  giving  rise  to  the  disorder,  but  no  previous  case  of  in- 
sanity was  recollected  in  any  branch  of  the  family.     Mr.  H 

now  began  to  talk  of  leaving  England  for  America,  in  order  to  avoid 
his  persecutors ;  and  to  prevent  this  he  was  placed  under  the  care  of 
a  private  keeper ;  while  with  this  person  he  frequently  and  bitterly  com- 


X  PEEFACE. 

plained  of  constant  pollutions  while  at  stool,  with  darting  pain,  and 
a  sense  of  weight  between  the  rectum  and  bladder.  He  had  also 
urethral  irritati'on  attended  with  discharge,  pains  in  his  loins,  and  in 
one  groin,  weakness  of  his  legs,  thick  urine,  piles,  and  obstinate  cos- 
tiveness.  He  kept  a  diary  at  this  time,  which  is  at  present  in  mj 
hands.  Not  a  day  is  passed  in  this  diary  without  mention  of  the  dis- 
tressing seminal  discharges  from  which  he  suffered.  These  were 
treated  as  of  no  importance  by  his  medical  attendants,  although  he 
never  ceased  to  complain  of  them,  and  solicited  aid  so  long  as  he  con- 
tinued in  confinement  in  England.  When  led  away  from  his  dis- 
order'into  any  discussion  on  public  matters,  he  was,  however,  a  most 
amusing  and  instructive  companion ;  as  a  man  of  business  he  was 
equally  acute,  and  to  a  stranger,  as  long  as  nothing  was  done  to  offend 
him,  he  was,  to  all  appearance,  a  man  of  observation  and  experience 
in  life.  For  about  two  years  and  a  half  he  was  under  the  care  of 
various  gentlemen,  devoted  to  the  insane,  and  at  length  he  was  dis- 
charged from  an  establishment  near  Bath,  by  the  visiting  magistrates, 
as  a  person  confined  without  due  cause.  His  first  act  was  to  com- 
mence legal  proceedings  against  his  friends  for  his  detention,  and 
having  gained  his  action,  he  immediately  proceeded  to  London,  and 
waylaid  and  violently  assaulted  a  gentleman  of  high  commercial 
standing  in  the  city.  After  this  offence  he  was  confined  for  a  con- 
siderable period  in  default  of  bail,  and  immediately  on  his  liberation 
it  is  believed  that  he  proceeded  to  America.  From  this  time  nothing 
was  heard  of  him  until  September,  1843,  when  a  letter  was  received 
b}^  a  gentleman  who  formerly  attended  him,  in  which  he  stated  that 
the  same  course  of  persecution  was  pursued  towards  him  in  America 
as  had  been  followed  in  England.  He  complained  of  not  being  able 
to  obtain  efficient  medical  treatment,  although  he  had  applied  to  the 
most  eminent  practitioners  in  Cincinnati,  and  afterwards  at  Philadel- 
phia and  New  York.  After  this,  nothing  more  was  heard  of  Mr. 
H until  the  year  1845,  when  an  American  newspaper  was  for- 
warded to  his  friends  by  an  unknown  hand,  containing  an  account 
of  his  death,  and  of  an  inquest  held  on  him,  headed,  "Death  of  a 
Hermit  in  West  Jersey."  It  was  stated  that  he  lived  on  a  small 
farm,  entirely  alone,  with  the  exception  of  a  dog,  and  that  he  had 
shunned  all  intercourse  with  his  neighbors.  He  was  taken  suddenly 
ill,  applied  to  a  neighboring  farmer  for  assistance,  but  died  in  the 
course  of  the  following  day.  From  information  subsequently  ob- 
tained by  his  friends,  it  is  believed  that  he  died  of  apoplexy,  or  per- 
haps, in  one  of  the  attacks  of  congestion  of  the  brain,  from  which 
he  frequently  suffered  before  he  left  his  native  country. 

The  symptoms  of  this  unfortunate  case  strongly  resemble  those  of 
tlie  thirty-second  and  fifty-sixth  cases  related  by  M.  Lallemand.  It 
was  more  aggravated,  however,  and  presented  the  somewhat  uncommon 
feature  of  the  patient's  discovering  the  fre,quent  pollutions,  and  con- 
stantly complaining  of  them :  these,  unfortunately,  were  treated  as 
matters  of  no  importance.     Mr.  H 's  insanity,  at  first,  constantly 


PREFACE,  XI 

bail  reference  to  his  liaviu^:  either  committed  or  been  accusetl  of  com- 
mitting  unnatural  crimes,  and  this  ideanever  entirely  left  him,  although 
during  the  latter  part  of  his  life,  his  more  prominent  hallucinations 
had  reference  to  imaginary  persecutors  constantly  watching  him,  and 
endeavoring  to  ruin  him  by  spreading  false  reports,  and  to  poison 
him  by  adulterating  his  food,  and  infusing  noxious  gases  into  the  air. 
There  can  be  little  doubt,  on  taking  into  consideration  his  complaints 
of  weight  between  the  rectum  and  bladder,  with  darting  pains,  &c,, 
in  the  same  region,  that  the  pollutions  arose  from  irritation  in  the 
neighborhood  of  the  prostate,  and  I  think,  that  if  at  an  early  period 
of  his  disease  this  had  been  relieved,  there  would  have  been  con- 
siderable hope  of  his  recovery  from  the  hallucinations  he  manifested. 
The  other  case  to  which  I  have  alluded  as  particularly  attracting 
ray  attention,  and  which  came  under  my  notice  about  the  same  time, 
was  that  of  a  young  man  of  high  intellectual  power  and  general  talents, 
studying  medicine.  This  gentleman  was  one  of  ray  most  constant 
Companions,  when  almost  suddenly  a  serious  change  came  over  him — 
he  shunned  society,  especially  that  of  females,  was  morose,  taciturn, 
and  frequently  shed  tears  ;  he  sat  sometimes  for  hours  in  a  kind  of 
abstraction,  and  on  being  aroused  from  it,  he  could  give  no  explana- 
tion of  his  thoughts  and  feelings ;  he  constantly  expressed  to  rae  his 
conviction  that  he  should  never  succeed  in  his  profession,  and  fre- 
quently exclaimed  that  he  was  ruined  both  here  and  hereafter — body 
and  soul — and  by  his  own  folly.  About  twelve  months  previous  to 
this  depression  of  spirits,  he  had  a  very  severe  attack  of  blennorrhagia, 
with  orchitis  and  phimosis.  This  left  a  degree  of  irritability  in  the 
bladder  which  required  him  to  pass  urine  frequently.  His  digestion 
became  so  disordered  that  the  simplest  food  would  not  remain  on  his 
stomach,  and  he  had  frequent  eructations  of  fluid  which  blazed  like 
oil  if  spit  out  into  the  fire.  This  gentleman's  father  was  a  physician, 
and  being  naturally  anxious  for  his  son,  obtained  for  him  the  advice 
of  many  of  the  most  eminent  of  the  faculty.  No  improvement  took 
place,  however.  After  he  had  been  six  months  in  this  state,  I  had  an 
opportunity  of  spending  three  weeks  by  the  sea  side,  and  my  friend 
accompanied  me.  We  slept  in  the  same  room,  and  he  was  scarcely 
ever  out  of  my  sight.  Before  our  return  his  health  was  almost  re- 
established, and  his  spirits  had  returned  to  their  natural  condition. 
Twelve  months  later,  however,  he  again  fell  into  the  same  state  of 
despondency,  and  this  time  his  condition  was  much  worse  than  on 
the  former  occasion.  He  frequently  remained  in  bed  three  parts  of 
the  day,  and  no  threats  or  entreaties  on  the  part  of  his  father  could 
induce  him  to  get  up.  His  intellectual  faculties  were  totally  pros- 
trated, and  a  vacant  stare  which  took  the  place  of  his  natural  lively 
expression,  induced  considerable  fears  of  his  ultimately  becoming 
idiotic.  I  was  the  only  person  who  possessed  any  influence  over 
him,  which  may  perhaps  be  attributed  to  his  feeling  that  I  was  aware 
of  the  cause  of  his  disorder.  This  state  continued  between  three  and 
four  months,  during  which  time  I  was  with  him  as  much  as  my  other 


^\[  PREFACE. 

duties  would  permit,  and  frequently  showed  him  the  folly  of  the 
course  he  pursued.  At  the  expiration  of  this  time  he  gradually  re- 
covered. He  has  since  had  a  slight  relapse  once  only  ;  he  has  pur- 
sued his  professional  studies  with  success,  and  is  at  present  a  medical 
officer  in  her  Majesty's  service. 

On  this  case,  I  need  only  remark  that  the  symptoms  did  not 
arise  from  involuntary  seminal  discharges,  but  from  excessive  dis- 
charges caused  by  abuse.  The  various  treatment  recommended  by 
the  distinguished  practitioners  consulted,  proved  unsuccessful,  be- 
cause the  origin  of  the  disorder  was  unrecognized,  and  the  remedies 
consequently  useless,  while  the  habit  of  abuse  was  continued. 

Such  were  the  two  cases  which  first  attracted  my  attention  to  the 
influence  of  the  generative  organs  over  the  system  generally,  and  the 
brain  especially;  and  my  suspicions  once  awakened,  further  observa- 
tions soon  convinced  me  of  their  correctness,  as  well  as  of  the  fre- 
quent occurrence  of  such  cases.  I  was  soon  convinced,  too,  that  the 
profession  generally,  either  were  not  aware  of  the  immense  import- 
ance of  these  discharges,  or  that,  by  a  kind  of  common  consent,  they 
neglected  to  recognize  a  subject  certainly  repugnant  to  delicacy. 
As  a  consequence,  sufferers  finding  themselves  neglected  by  their 
ordinary  medical  attendants,  rush  to  find  relief  wherever  there  seems 
to  them  the  slightest  chance  of  its  being  obtained  ;  and  the  ignorant 
and  rapacious  advertising  quacks  have  a  rapid  and  profitable  sale  for 
their  injurious  nostrums.  Several  cases  of  gross  imposition  by  these 
charlatans  have  come  under  my  notice,  which  it  is  my  intention,  at 
some  future  period,  to  lay  before  the  profession  in  one  of  our  medi- 
cal periodicals.  Their  introduction  here  would  swell  these  prefa- 
tory observations  to  an  inconvenient  length. 

It  now  remains  for  me  to  make  a  few  remarks  on  one  or  two  points 
of  my  own  experience  respecting  the  symptoms  and  treatment  of 
spermatorrhoea.  One  symptom  which  I  have  three  times  met  with  as 
the  result  of  masturbation,  is  little  more  than  alluded  to  by  M.  Lalle- 
mand — I  mean  epilepsy.  Masturbation  is  admitted  by  most  medical 
men  to  be  a  frequent  cause  of  epilepsy  ;  and  I  am  surprised  to  find 
that  M.  Lallemand  has  related  no  cases  in  which  epilepsy  occurred. 
Two  of  the  three  cases  to  which  I  have  alluded  were  simple  uncom- 
plicated cases  of  epilepsy  brought  on  by  masturbation.  In  these, 
after  the  masturbation  had  been  arrested  the  effect  ceased.  The  third 
case,  however,  was  by  no  means  so  successful;  it  occurred  in  a  hid 
of  weak  intellect  aged  sixteen.  The  attacks  of  epilepsy  frequently 
took  place  as  often  as  twice  in  the  day.  He  admitted  that  he  was  in 
the  constant  habit  of  practising  masturbation,  and  even  seemed  aware 
of  the  influence  the  practice  had  in  producing  his  fits.  I  have  reason 
to  believe  that  this  lad  corrected  himself;  but  from  the  weakness  of 
his  intellect,  much  dependence  could  not  be  placed  on  his  statements. 
As  long  as  he  continued  to  attend  the  dispensary  at  which  I  saw  him, 
little  improvement  took  place  in  his  general  health,  and  the  epileptic 
paroxysms  continued  very  frequent.     I  regret  that  I  took  no  notes  of 


PREFACE.  xiii 

this  case,  and  still  more  that  I  lost  sight  of  the  patient,  as  I  am  in- 
clined to  believe  that  the  epileptic  paroxysms  might  have  been  kept 
up  by  involuntary  seminal  discharges,  after  having  been  once  ex- 
cited by  masturbation.  This  is  a  point  which  I  earnestly  recommend 
to  the  attention  of  the  profession. 

Another  very  frequent  symptom  in  cases  of  spermatorrhoea,  is  the 
occurrence  of  urethral  discharge  from  very  slight  excitement.  Several 
cases  of  this  kind  have  come  under  my  notice,  the  patients  having 
consulted  me  on  account  of  the  discharge.  These  cases  often  give 
rise  to  distressing  suspicions,  and  much  family  unhappiness,  espe- 
cially as  they  often  occur  in  married  men.  The  symptoms  are  often 
almost  as  severe  as  those  of  a  virulent  clap,  and  the  discharge  is  at- 
tended with  great  irritation  in  the  neighborhood  of  the  prostate,  and 
frequent  desire  of  micturition.  The  discharge  came  on  in  one  case 
of  a  married  man  who  consulted  me,  after  taking  a  single  tumbler 
of  whiskey  and  water  at  night — this  gentleman  not  having  been  in 
the  habit  of  taking  spirits  for  several  years,  on  account  of  continued 
ill  health.  The  discharge  in  these  cases  is  thicker  than  that  of  or- 
dinary clap,  and  sticks  in  patches  on  the  linen.  These  patches  may 
be  scaled  off,  after  which  there  is  little  mark  left,  and  the  discharge 
seldom  penetrates  through  calico,  so  that  on  the  opposite  side  of  the 
shirt  there  is  little  or  no  appearance  of  stain.  On  wetting  the  linen, 
the  discharge  feels  slippery,  and  it  is  washed  off  with  difficulty.  I 
am  inclined  to  believe  that  these  discharges  are  not  contagious  ;  but 
notwithstanding  this,  sexual  intercourse  should  be  avoided  on  account 
of  the  injury  that  may  result  to  the  patient  himself.  In  most  cases, 
indeed,  connection  is  impossible  during  the  first  stages  of  the  dis- 
charge, on  account  of  the  painful  chordee  to  which  excitement  gives 
rise. 

I  have  generally,  on  questioning  these  patients,  found  that  such 
discharges  were  connected  more  or  less  with  deficiency  of  generative 
power.  In  the  case  I  have  above  alluded  to.  impotence  was  almost 
complete  ;  and  in  another  similar  case  occurring  in  the  person  of  a 
married  surgeon,  the  powers  had  greatly  declined.  Both  these  pa- 
tients were  in  the  prime  of  life,  and  both  had,  in  their  youth,  led 
very  irregular  lives. 

The  irritation  in  these  cases,  I  am  inclined  to  believe,  is  situated 
in  the  posterior  part  of  the  urethra.  Indeed,  the  surgeon  whose 
case  I  have  just  alluded  to,  believed  himself  affected  by  enlarged 
prostate — many  of  the  symptoms  of  which  generally  accompany  the 
discharge  I  have  described,  especially  frequent  desire  to  pass  w^ater, 
and  a  feeling  as  though  the  bladder  were  never  completely  emptied, 
or  as  though  two  or  three  drops  of  urine  were  retained  in  the  pos- 
terior part  of  the  urethra. 

In  the  treatment  of  these  cases,  I  have  found  the  application  of  the 
solid  nitrate  of  silver  most  effectual.  The  condition  of  the  mucous 
membrane  is  immediately  modified  by  it ;  within  twelve  hours  the 


xiv  PEEFACE. 

patient  experiences  a  degree  of  comfort  to  which,  very  frequently,  he 
has  loner  been  a  stranger.  The  condition  of  the  membrane,  too,  seems 
permanently  altered  by  this  treatment ;  and  the  discharge  has  never, 
as  far  as  my  experience  goes,  returned  after  subsequent  excitement — 
a  circumstance  which  is  very  apt  to  occur  when  the  discharge  has 
been  arrested  by  other  means.  The  involuntary  seminal  discharges 
often  present  in  these  cases,  and  to  which  the  diminution  of  virile 
power  is  generally  due,  are  also  at  the  same  time  arrested,  and  the 
patient  experiences  a  return  of  vigor  wholly  unexpected. 

This  peculiar  form  of  urethral  discharge  has  hitherto  for  the  most 
port,  I  believe,  been  confounded  with  contagious  clap ;  indeed,  many 
members  of  our  profession  are  in  the  habit  of  setting  down  all  dis- 
charges from  the  urethra  indiscriminately  as  the  result  of  impure  con- 
nection, however  positive  the  patient  may  be  that  such  has  not  taken 
place.  In  all  the  cases  I  have  hitherto  met  with,  however,  the  pa- 
tients have  admitted  that  they  had  previously  been  affected  with  con- 
taf^ious  clap — frequently  on  more  than  one  occasion.  The  discharges 
I  have  described  are,  I  am  inclined  to  believe,  from  the  number  of 
cases  I  have  met  with  since  my  attention  was  first  attracted  by  the 
subject,  by  no  means  uncommon,  and  certainly  deserving  the  careful 
attention  of  the  profession. 

The  diagnosis  of  spermatorrhoea,  in  aggravated  and  long-standing 
cases,  is  by  no  means  easy.  When  frequent  diurnal  pollutions  have 
deteriorated  the  patient's  health — discharge  of  watery  semen  taking 
place  almost  every  time  the  patient  makes  water — the  spermatozoa 
are  often  only  distinguishable  under  the  microscope  after  a  long-con- 
tinued and  patient  manipulation;  and  perhaps  for  no  researches  con- 
nected with  medical  science  is  it  more  important  to  possess  one  of  the 
best  microscopes.  When  I  first  commenced  the  study  of  this  subject, 
I  was  more  than  once  tempted  to  give  it  up  in  despair,  in  consequence 
of  my  not  possessing  a  perfect  microscope.  At  present  I  use  one  of 
Powell's  instruments,  which  I  prefer  to  those  constructed  by  Ross,  on 
account  of  the  greater  convenience  of  the  motions  of  the  stage — a 
matter  which  will  be  found  of  much  importance  in  all  researches  re- 
quiring delicate  manipulation.  The  eighth  of  an  inch  object  glass 
will  be  found  almost  indispensable  in  the  study  of  these  cases,  al- 
though the  spermatozoa  in  healthy  semen  can  be  perfectly  well  exa- 
mined with  an  object  glass  of  a  quarter  of  an  inch  focal  length. 

M.  Lallemand  has  described  the  operation  of  cauterization  as  a 
very  painful  one,  and  its  after  effects  as  very  severe.  This  by  no 
means  accords  with  my  experience.  In  no  case  in  which  I  have 
performed  the  operation  has  the  pain  been  severe,  or  the  subsequent 
inflammation  violent  ;  indeed,  I  have  several  times  had  difficulty  in 
persuading  the  patients  to  remain  twenty-four  hours  in  bed  after  the 
operation — a  precaution  which  I  have  thought  advisable  in  all  cases. 
At  first  I  feared  that  sufficient  inflammation  had  not  been  excited,  and 
that  the  operation  would  require  to  be  repeated — this  has  only  hap- 


PREFACE.  XV 

pened  in  my  practice  once,  however,  and  in  that  case  I  am  inclined 
to  think  that  the  caustic  was  not  properly  applied  to  the  surface  of 
the  prostate  on  the  first  occasion. 

The  instrument  commonly  sold  for  the  purpose  of  cauterizing  the 
prostate,  by  instrument  makers  in  this  country,  is,  in  my  opinion, 
exceedingly  defective.  From  its  being  made  nearly  straight,  it  is  by 
no  means  easily  introduced  while  the  patient  is  lying  down — and  in 
no  other  position  ought  the  operation  to  be  attempted — the  irrita- 
bility of  the  canal,  too,  increases  the  difficulty  of  introduction,  and 
consequently  every  possible  facility  should  be  given  to  the  operator, 
by  having  the  instrument  constructed  of  a  convenient  form.  It  is 
difficult,  also,  to  measure  the  length  of  the  passage  exactly  by  apply- 
ing a  curved  catheter  to  a  nearly  straight  porte-caustique.  I  have, 
therefore,  had  an  instrument  constructed  of  precisely  the  same  curve 
as  the  catheters  I  generally  use.  This  instrument  is  rather  larger 
than  those  generally  sold,  being  about  the  size  of  a  number  6  cathe- 
ter, and  its  bulbous  extremity  is  two  sizes  larger,  or  as  large  as  a  No. 
8  catheter ;  with  this  instrument  many  of  the  difficulties  of  cauteri- 
zation are  avoided.  It  can  be  easily  introduced  like  an  ordinary 
catheter  while  the  patient  is  lying  on  his  back  ;  the  moment  when  the 
bulb  enters  the  neck  of  the  bladder  is  clearly  distinguishable  by  the 
sensation  communicated  ;  and  the  caustic,  on  account  of  the  greater 
size  of  the  curvette,  is  more  fairly  applied  to  the  whole  of  the  infe- 
rior surface  of  the  urethra,  which  is  to  a  certain  extent  distended  by 
its  presence.  With  regard  to  the  other  precautions  to  be  used,  I 
quite  agree  with  M.  Lallemand. 

In  translating  the  following  pages,  I  have  endeavored  more  to 
render  the  sense  of  the  author  in  as  few  words  as  possible,  than  to 
give  a  full  and  literal  translation.  I  must  beg  my  readers  to  bear 
in  mind,  that  M.  Lallemand's  treatise  consists  of  three  thick  octavo 
volumes — these  having  been  written  at  different  periods,  there  are 
of  course  many  repetitions,  which  I  have,  as  much  as  possible,  en- 
deavored to  avoid.  The  total  number  of  cases  related  by  M.  Lalle- 
mand is  one  hundred  and  fifteen.  Of  these  I  have  selected  sixty- 
two,  which,  after  mature  consideration,  appear  to  me  to  illustrate  the 
subject  sufficiently.  The  same  reason  which  induced  me  to  omit  so 
many  of  M.  Lallemand's  cases,  has  prevented  me  from  inserting 
cases  from  my  own  experience.  As  I  have  endeavored  to  render 
this  entirely  a  practical  work — I  have  omitted  M.  Lallemand's  inter- 
esting researches  on  the  spermatozoa,  except  as  far  as  they  refer  to 
the  diagnosis  of  spermatorrhoea,  as  well  as  several  digressions  made 
by  M.  L.  to  topics  of  no  practical  interest  in  this  country  ;  of  these 
a  disquisition  on  the  character  of  J.  J.  Rousseau  is  one  of  the  most 
remarkable. 

In  speaking  of  spermatorrhcea  arising  from  contagious  urethritis, 
I  have  avoided  the  word  gonorrhoea  as  being  a  misnomer,  substi- 
tuting for  it  blennorrJiagia,  which  is  certainly  more  correct  in  its 
derivation,  although  also  liable  to  some  objections. 


■^y{  PEEFACE. 

I  conclusion,  I  must  beg  to  express  my  thanks  to  M.  Lallemand 
for  the  kind  and  complimentary  manner  in  which  he  was  pleased  to 
erant  me  permission  to  undertake  my  task,  as  well  as  for  the  aid  he 
has  more  than  once  afforded  me  in  performing  it.  If  through  the 
medium  of  the  following  pages  the  profession  becomes  more  fully 
acquainted  with,  and  consequently  better  able  to  relieve,  one  of  the 
most  distressing  disorders  that  affect  mankind,  I  shall  feel  perfectly 
satisfied  in  the  conviction,  that  the  time  I  have  appropriated  to  the 
subject  has  not  been  entirely  misspent. 

29,  Berners  Street. 


CONTENTS. 


Page 
Author's  Preface  ...'...     xiii 

Editor's  Preface  .  .  .  .  .  .      xv 


CHAPTER  I. 
Lntroduction   ...  .  .  .  .       33' 


CHAPTER  II. 

INFLAMMATION  OF  THE  SPERMATIC  ORGANS. 

Pathological  Anatomy  .  .  .  .  .36 

Case  I. — Blennorrhagia — Diurnal  Pollutions — Hypochondriasis — Chro- 
nic affection  of  the  Brain  and  its  Membranes — Death.  Autopsy — 
Right  Kidney  in  a  state  of  Suppui-ation — Prostate  nearly  de- 
stroyed. Ejaculatory  Ducts  ulcerated — Seminal  Vesicles  altered 
— Nothing  remarkable  in  the  other  organs  .  .  .37 

Case  II.  —  Blennorrhagia  —  Spermatorrhoea  —  Hypochondriasis  —  Fre- 
quent attacks  of  Cerebral  Congestion — Death.  Autopsy — Suppu- 
ration in  the  Seminal  Vesicles — Ossific  deposit  in  the  Vasa  Defer- 
entia — Cystitis — Phlebitis — Old  adhesions  of  the  Arachnoid  and 
Pleurte — Abscesses  in  the  muscles  of  the  Neck  and  Shoulders     .        42 

Case  III. — Blennorrhagia — Retention  of  Urine,  &c. — Apoplexy — Death. 
Autopsy — Effusion  of  Blood  into  the  left  Ventricle  of  the  Brain — 
Hypertrophy  of  the  Heart — Gastro-enteritis — Abscess  and  Tuber- 
cles in  the  Kidney  and  Prostate — Stricture,  &c.    .  .  .46 

Case  IV. — Mental  Derf^ngement — Belief  in  a  change  of  Sex — Death — 
Autopsy — Thickening  of  the  Arachnoid — Great  alteration  of  the 
Prostate — Atrophy  and  obliteration  of  the  ejaculatory  Ducts        .         49 

Summary  of  the  preceding  Observations. — Symptoms  .       49 

Lesions  in  the  Prostate            .             .             .             .  .51 

In  the  Spermatic  Organs              .             .             .  .63 

In  the  Orifices  of  the  Ejaculatory  Ducts              .  .       54 

2 


XVlll 


CONTENTS. 


In  the  Ejaculatory  Ducts 
In  the  Seminal  Vesicles  . 
In  the  Qualities  of  the  Semen 
In  the  Vasa  Deferentia  . 
In  the  Testicles  . 
In  the  Urinary  Organs   . 

Comparison  of  the  two  Sets  of  Organs 

Resumd      *     . 


54 
55 
55 
55 

57 
57 
53 
61 


CHAPTER  III. 

CAUSES  OF  SPERMATORRH(EA. 

Blennorrhagia  .  .  .  .  .  .62 

Case  V. — Lymphatic  Temperament — Blennorrhagia — Orchitis — Nephri- 
tis— Nocturnal  and  Diurnal  Pollutions — Abuse  of  Mercurials — 
Injurious  effects  of  Cold  and  Tonics — Cure  by  means  of  Leeches, 
the  use  of  Flannel  and  Milk  Diet — Fresh  attack  of  Blennorrhagia 
— Same  Treatment  with  the  same  Result    .  .  .  .62 

Case  VL — Masturbation — Blennorrhagia — Diurnal  Pollutions — Failure 
of  the  ordinary  modes  of  Treatment — Cauterization  of  the  Pros- 
tatic Portion  of  the  Urethra — Rapid  Recovery        .  .  .66 

Case  VII. — Abuse  of  Spirituous  Liquors — Blennorrhagia — Nocturnal 
Pollutions — Impotency — Frequent  discharge  of  Urine — Cauteri- 
zation— Cure  .  .  .  .  .  •  .     •   69 

Case  VIII. — Masturbation — Blennorrhagia,  repeated  anti-venereal 
Treatment — Diurnal  Pollutions — Increasing  Weakness,  especially 
of  the  Mental  Faculties — Extreme  Emaciation — Cauterization, 
and  Cure  after  Sixteen  Years — Venereal  Excess,  Relapse — Cau- 
terization again  performed  with  success      .  .  .  .71 

Case  IX. — Blennorrhagia  followed  by  Excoriations  of  the  Glans  Penis 
— Spermatorrhoea — Cauterization  unsuccessful — Artificial  Sul- 
phur Baths — Cure  ......        74 

Consideration  of  the  Causes    .             .             .             .  .75 

Mode  of  Action          .            .            .             .            .  .77 

Treatment  of  Spermatorrhoea  following  Blennorrhagia  .       79 

Symptoms  of  Spermatorrhoea  arising  from  Blennorrhagia  .       80 


CHAPTER  IV. 


CAUSES  OF  SPERMATORRH(EA — CONTINUED. 

Cutaneous  Affections  .  .  .  .  .81 

Case  X.— Itch  during  Ten  Months,  at  about  the  age  of  Fourteen— Pain 
in  the  Epigastrium — Tumor  of  the  Testicle — Chronic  Inflam- 
mation of  the  Bladder— Diurnal  Spermatic  Discharges — Hypo- 
chondriasis.    Cure  by  Cauterization  at  the  age  of  Twenty-eight  .        81 


CONTENTS.  Xix 

Case  XI. — Cutaneous  affections — Repeated  Attacks  of  Urethritis — Appli- 
cation of  the  Nitrate  of  Silver — Cure  .  .  .83 

Case  XII. — Pruriginous  Eruption  around  the  Genital  Organs — Two  at- 
tacks of  Blennorrhagia — Nocturnal  and  Diurnal  Pollutions — 
Cure  by  means  of  Sulphuretted  Baths  .  .  .85 

Case  XIII. — Herpes  Prteputialis,  alternating  in  a  remarkable  manner 
with  Irritation  in  the  Prostatic  Portion  of  the  Urethra — Noctur- 
nal and  afterwards  Diurnal  Pollutions — Occasional  Impotence — 
Ile-egtablishment  by  Cauterization — Relapse — Cure  by  the  Baths 
of  Vernet  ...  ....         86 

Case  XIV. — Lymphatic  Temperament — Various  Cutaneous  Eruptions 
alternating  with  other  Affections — Habitual  bad  Health — Hypo- 
chondriasis— Spermatorrhoea  undiscovered  during  Twenty-five 
Years — Cure  by  Sulphuretted  Baths   .  .  .  .88 

Consideration  of  Causes  .  .  .  .  .90 

Mode  of  Action          .  .  .  .  .  .91 

Irritation  of  the  Rectum  .  .  .  .  ,92 

Treatment  of  these  Cases  .  .  .  .  .       92 


CHAPTER  V. 

CAUSES  OF  SPERMATORRIKEA— CONTINUED. 

Influence  of  the  Rectum         .  .  .  .  .93 

Case  XV. — Spermatorrhoea  from  a  Mechanical  Obstacle  to  Defecation — 

Division  of  the  Stricture — Rapid  and  Complete  Cure      .  .         93 

Case  XVI. — Spermatorrhoea  induced  by  Chronic  Diarrhoea,  and  kept  up 
by  a  Mechanical  Obstacle  to  defecation — Removal  of  a  Scirrhous 
Tumor  from  the  anus — Rapid  and  Perfect  Cure  .  .         94 

Case  XVII. — Hemorrhoids  from  the  age  of  Puberty — Difficulty  in  evac- 
uating the  Rectum  at  the  age  of  Twenty-eight — Spermatorrhoea 
—Cure         .......         67 

Case  XVIII. — Blennorrhagia,  Constipation — Fissure  of  the  Anus — Dis- 
charge of  Semen  at  Stool — Profound  Hypochondriasis — Desire  of 
committing  Suicide — Diarrhoea — Cure  of  the  Fissure  of  the  Anus 
— Disappearance  of  the  other  Symptoms  .  .  .93 

Case  XIX. — Horse  Exercise  —  Constipation  —  Spermatorrhoea — Impo- 
tence— Frequent  and  violent  Attacks  of  Cerebral  Congestion — 
Ascending  Douches — Cauterization — Sulphur  Baths — Hot  and 
Cold  Douches  on  the  Loins  and  Perineum — Cure  .  .       100 

Case  XX. — Lengthened  exposure  to  severe  Cold — Incomplete  Paralysis 
of  the  Rectum — Seminal  Discharges  during  Defecation — Cure  by 
the  application  of  Galvanism  ....       105 

Case  XXI. — Intemperance — Lengthened  exposure  to  Cold — Chronic  In- 
flammation of  the  Bladder — Involuntary  Seminal  Discharges,  &c. 
— Cauterization — Cure — Relapse — Same  Treatment  with  the  same 
Result — Remarkable  influence  of  the  Bladder  on  the  Rectum      .       108 

Case  XXII. — Unsuspected  Spermatorrhoea — Attacks  of  Cerebral  Con- 
gestion— Disorder  of  the  General  Health — Ascarides  expelled 
from  the  Rectum,  with  immediate  Recovery      .  .  .       Ill 


XX 


CONTENTS. 


Case  XXIII.— Masturbation  at  Nine  Years  of  Age— Constant  Nocturnal 

Emissions— Ascarides— Cure  in  Eight  Days  .  .       113 

Case  XXIV. — Hypochondriasis — Impotence — Attacks  of  Cerebral  Con- 
gestion— Ascarides— Cure  within  Eight  Days  .  .114 

Case  XXV. — Nocturnal  Pollutions  resisting  all  modes  of  Treatment 
during  Six  Years — Great  Physical  and  Moral  Depression — Ex- 
pulsion of  Ascarides  with  complete  Relief        .  .  .114 

Case  XXVI. — The  habit  of  Masturbation  contracted  spontaneously  at  the 
atre  of  Fifteen,  and  continued  until  the  age  of  Twenty — Nocturnal 
and  Diurnal  Pollutions — Increasing  Disorder  of  the  Health  until 
the  age  of  Twenty-nine — Frequent  and  prolonged  Erections — Pain 
at  the  Margin  of  the  Anus,  &c. — Cauterization  performed  without 
Benefit — The  expulsion  of  Ascarides  followed  by  rapid  Recovery       117 

Case  XXVII. — Masturbation  at  the  age  of  Fifteen — Serious  disorder — 
The  application  of  a  Blister  followed  by  Involuntary  Nocturnal 
Emissions — Cauterization,  Douches,  &c.,  unsuccessful — Expulsion 
of  Ascarides  followed  by  a  rapid  Recovery       .  .  .119 

Remarkable  case  of  Urethral  Discharge  kept  up  by  Ascarides 

— Editor's  note  to  page  ....     121 

Case  XXVIII. — Masturbation  at  the  age  of  Ten — Seminal  Emissions 
produced  by  Horse  Exercise — Nocturnal,  and  afterwards  Diurnal 
Pollutions — Constant  Erections — Stools  Relaxed,  and  containing 
abundance  of  Mucus — Burning  at  the  Anus — Cauterization,  with 
slight  benefit — Expulsion^  of  Ascarides  followed  by  rapid  and 
complete  Recovery   ......       123 

Resume  .......     125 


CHAPTER  VI. 

CAUSES  OF  SPERMATORRHCEA — CONTINUED. 

Abuse 126 

Case  XXIX. — Masturbation — Nocturnal  Pollutions — Palpitation  and 
Dyspnoea  simulating  Cardiac  Disease — Repeated  Venesection  fol- 
lowed by  increased  Disorder — Sulphuretted  Baths  and  rapid  Re- 
covery       .......      126 

Case  XXX. — Masturbation  at  the  age  of  Eight  Years — At  Twelve,  very 
frequent  Emissions  of  Urine— At  Sixteen,  Coitus  Impossible — 
Nocturnal  and  afterwards  Diurnal  Pollutions — Cauterization  at 
the  age  of  Twenty-eight,  followed  by  rapid  Recovery     .  .       127 

Case  XXXI. — Masturbation  at  the  age  of  Seventeen,  carried  so  far  as 
to  cause  emission  of  Blood,  but  soon  afterwards  abandoned — In- 
creasing Debility  during  Four  Years — Symptoms  of  Phthisis 
Laryngea  and  Chronic  Gastritis — Extreme  Prostration — Cauteri- 
zation followed  by  rapid  re-establishment  .  .  .       130 

Case  XXXII. — Masturbation  from  Twelve  to  Twenty-one  Years  of  age 
— Melancholy — Inclination  to  Suicide — Serious  alteration  of  the 
Health — Monomania — Unperceived  Diurnal  Pollutions — Cauteri- 
•zation  followed  by  perfect  Recovery    .  .  .  .131 


CONTENTS. 


XXI 


Case  XXXIII. — Abuse  caused  by  sleeping  on  the  Belly — Efifects  of 
reading  Erotic  Works — Power  of  Habit — Alteration  of  the  intel- 
lectual and  moral  Faculties — Impotence — Chronic  Irritation  of 
the  Bladder — Nocturnal  and  Diurnal  Pollutions — Cauterization 
followed  by  prompt  Recovery  ..... 

Case  XXXIV. — Sexual  ideas  at  the  age  of  Eight — Abuse  at  thirteen — 
Various  diseases  in  consequence,  until  the  age  of  Thirty-two — 
Nocturnal  and  Diurnal  Pollutions — Cauterization — Slow,  but  pro- 
gressive improvement  ...... 

Case  XXXV. — Masturbation  at  Sixteen  Years  of  Age — At  Twenty-one, 
compression  of  the  Uretha  during  Ejaculation,  followed  by  a  sen- 
sation of  tearing,  and  acute  pain — Urethral  Discharge  recurring 
frequently — Discharges  of  Semen  during  Defecation  and  the  emis- 


sion of  Urine — Reciprocal  Influence  of  the  D 
gestive  Organs — Chronic  Catarrh  of  the  Bladder 
Recovery  after  several  relapses 

Causes  of  Abuse 

Internal  or  Predisposing  Causes 

External  or  Exciting  Causes  . 

Varieties  of  Abuse 

Effects  of  Abuse 

Effects  on  Children  and  on  Females 

Effects  of  Temperament,  Idiosyncrasy,  &c. 

Urethral  Discharges  following  Abuse 

Prostatitis       .... 

Cystitis  .... 

Emissions  of  Blood     . 

Orchitis  .... 


scharges  on  the  Di- 
Cauterization — 


135 


137 


139 
142 
143 
143 
148 
153 
155 
158 
158 
159 
159 
159 
159 


CHAPTER  VII. 


CAUSES  OF  SPERMATORRHCEA — CONTINUED. 

Venereal  Excesses       ......     161 

Case  XXXVI. — Nervous  Temperament — Excessive  Intercourse  at  the 
age  of  Twenty-one,  continued  during  Eighteen  jMonths — Increas- 
ing Derangement  of  Health — Symptoms  of  Gastritis,  and  of  disease 
of  the  Heart — Repeated  Abstraction  of  Blood — Nocturnal  and 
afterwards.  Diurnal  Pollutions ;  Milk  Diet,  &c. — Acupuncture 
followed  by  perfect  Recovery  .....       161 

Case  XXXVII. — Robust  Constitution — Venereal  Excesses  continued  till 
the  age  of  Twenty-four — Chronic  Inflammation  of  the  Bladder — 
Nocturnal  and  Diurnal  Pollutions — Cauterization  followed  by  per- 
fect Recovery  .......       105 

Case  XXXVIII. — Three  attacks  of  Blennorrhagia — Hypochondriasis — 
Danger  of  Suicide — Recovery — Marriage  a  few  months  after — 
Change  in  the  moral  Faculties — Disordered  Digestion — Consti- 


XXll 


CONTENTS. 


pation Agitation — Insomnia — Fits    of   Passion —Symptoms    of 

Mental  Derangement — Impotence — Nocturnal  and  Diurnal  Pol- 
lutions  Cauterization  followed  by  rapid  Recovery — Excesses  Re- 
peated— Relapse        ....... 

Case  XXXIX. — Strong  Constitution — Masturbation  at  the  age  of  Seven- 
teen  Serious  disorder  of  the  Health  until  Twenty-six — Marriage 

Rapid  Improvement — Gradual  Relapse  after  Three  Years,  not- 
withstanding the  cessation  of  Coitus — Seminal  Discharge  during 
Defecation  and  the  emission  of  Urine — Hypochondriasis — Inflam- 
mation of  the  Genito-urinary  Organs — Cauterization — Rapid  and 
complete  Cure  ....... 

Case  XL. — Sanguineous  Temperament — Masturbation  from  Fourteen  to 
Eighteen  Years  of  age — Marriage  at  Nineteen — Immediate  im- 
provemeut  in  the  Health — Afterwards  disorder  of  the  System — 
Hypochondriasis — Inclination  to  Suicide — Symptoms  of  Chronic 
Gastritis  treated  for  Six  Years  with  Leeches,  Blisters,  &c. — Noc- 
turnal and  Diurnal  Pollutions — Frequent  Discharge  of  Urine — 
Cauterization  followed  by  a  rapid  and  complete  Cure 

Case  XLI. — Nervous  Temperament — Delicate  Health — Masturbation  be- 
fore Puberty — Urethral  discharge  after  Sexual  Intercourse — Or- 
chitis— Nocturnal  Pollutions  —  Absolute  Impotence  —  Injection 
with  Solution  of  Nitrate  of  Silver  unsuccessful — Cauterization 
followed  by  rapid  Cure         ...... 

Case  XLII. — Masturbation — Venereal  Excesses — Prolonged  Horse  Ex- 
ercise— Blennorrhagia — Nocturnal  and  Diurnal  Pollutions — Two 
Cauterizations — Recovery — Premature  Excesses — Relapse — Cure 
by  another  Cauterization     ...... 

Case  XLIII. — Lymphatic  Temperament — Early  and  Long  continued 
Masturbation — Horse  Exercise — Infrequent  Coitus — Urethritis — 
Repeated  attacks  of  Inflammation  in  the  Testicles — Frequent  dis- 
charge of  Urine — Pollutions  during  Defecation — Imperfect  Ejacu- 
lation— Two  Cauterizations  followed  by  perfect  Recovery 

Case  XLIV. — Lymphatico-Sanguineous  Temperament — Coitus  when 
nearly  intoxicated,  at  the  age  of  Twenty-two — Blennorrhagia — 
Pollutions  during  Defecation — Disturbance  during  Ejaculation — 
Band  in  the  membranous  portion  of  the  Urethra — Cauterization — 
Cure  by  means  of  Antiphlogistics  and  Rest 

Case  XLV. — Coitus  in  a  state  approaching  Inebriety — Gleet  increased 
by  a  Journey — Diurnal  Pollutions — Cauterization  with  rapid  Im- 
provement— Relapse  from  premature  fatigue  of  the  Organs — Cure 
lay  means  of  Antiphlogistics  and  Rest 

Resume 

Characteristics  of  Venereal  Excesses 

Age    . 

Temperament 

Genital  Instinct 

Diflferences  of  Genital  Development 

Influence  of  Encephalic  Organs 

Accidental  Influences 

General  Effects  of  Venereal  Excesses 

Special  Eff"ects  of  Venereal  Excesses 


166 


170 


172 


173 


175 


180 


182 
183 
184 
187 
188 
188 
188 
188 
191 
192 
192 


CONTENTS.  XXlll 


CHAPTER  VIII. 

CAUSES   OF   SPERMATORRHGEA — CONTINUED. 

Action  of  certain  Medicines  .....     196 

Astringents     .......     196 

Case  XLVI. — Intermittent  Fever — Large  Dose  of  Bark — Obstinate  Con- 
stipation— Diurnal  Pollutions — Symptoms  of  Chronic  Gastritis, 
and  of  Disease  of  the  Heart — The  use  of  Douches  followed  by 
rapid  Improvement  .....       196 

Purgatives      .......     197 

Narcotics        .......     198 

Case  XLVII. — Frequently  repeated  Narcotism  at  the  age  of  Sixteen 
from  the  Vapor  of  Tobacco — Dilatation  of  the  Pupils — Vomiting 
— Constant  Headache — Constipation — Nocturnal  and  Diurnal  Pol- 
lutions— Impotence  —  Cauterization  at  the  age  of  Nineteen — 
Rapid  Recovery       .....  .       198 

Case  XLVIII. — Nervous  Temperament— Repeated  Narcotism  from  Smok- 
ing betvreen  the  ages  of  Twenty  and  Twenty-two — Impotence,  &c.       200 

Cantharides     .......     201 

Camphor  .  .  .  .  .  .  .202 

Nitrate  of  Potass        .  .  .  .  .  .202 

Ergot  of  Rye  .  .  .  .  .  .203 

Coffee  .  .  .  .  .  .  .203 

Case  XLIX. — Excessive  use  of  Coffee — Frequent  and  profuse  Discharge 
of  Urine — Nocturnal  and  afterwards  Diurnal  Pollutions — Impo- 
tence, &c. — Cauterization — Sulphuretted  Baths — Recovery  .       204 

Tea    . 205 


CHAPTER  IX. 

CAUSES   OF   SPERMATORRHEA — CONTINUED. 

Action  of  the  Cerebro-spinal  System  ....     206 

Case  L. — Masturbation — Extreme  weakness  of  the  Limbs  and  Senses — 
Erections  exited  by  Percussion  of  the  Occiput — Catheters  left  in 
the  Urethra — Rapid  Recovery  ....       207 

Case  LI. — Sickly  Childhood  —  Nervous  Temperament  —  Masturbation 
Rare — Coitus  still  more  so — Symptoms  of  Aneurism  and  Gastritis 
— Nocturnal  Pollutions — Predominance  of  Erotic  Ideas — Tension 
at  the  Nucha — The  application  of  cold  Lotions  to  this  Region  fol- 
lowed by  considerable  Improvement  ....       208 

Action  of  the  Spinal  Cord      .....     211 


xxiv  CONTENTS. 

CHAPTER  X. 

CAUSES    OF   SPERMATORRHEA— CONTINUED. 

Congenital  Predisposition        .....     21_ 
Sebaceous  Matter       ...•••     213 
Case  LII.— Natural  Phimosis— Frequent  Nocturnal  Pollutions  from  the 
age  of  Puberty— Abundant  and  Fetid  sebaceous  Secretion  be- 
tween the  Glans  and  Prepuce— Circumcision  at  the  age  of  Twenty- 
three  followed  by  immediate  Relief    ....       213 

Natural  Phimosis        ......    214 

Case  LIII.— Natural  Phimosis- Erections  at  the  age  of  Eight— At- 
tempts at  Coitus  at  Nine— Vesical  Catarrh— Diurnal  Pollutions 
— Paraplegia,  &c.    ....  •  •       -1^ 

Case  LIV.— Very  long  Prepuce— Badly  developed  Genital  Organs- 
Childhood  Delicate — Incontinence  of  Urine — Sebaceous  Discharge 
from  the  Orifice  of  the  Prepuce  at  the  age  of  Ten — Nocturnal 
Pollutions  increasing  in  frequency — Hypochondriasis — Loss  of 
Memory  and  failure  of  Intellect — Constipation — Diurnal  Pollu- 
tions— Constant  application  of  Lotions  attended  by  Relief— Cir- 
cumcision at  the  age  of  Twenty-eight,  followed  by  Cure  .  .      217 

Case  LV.— Very  long  Prepuce — Badly  developed  erectile  Tissues — 
Abundant  Secretion  of  Sebaceous  Matter — Seminal  emissions 
induced  by  Horse  Exercise,  and  afterward,  by  incomplete  Inter- 
course— Marriage  unconsummated  during  Five  Years — Diurnal 
Pollutions — Circumcision  followed  by  rapid  Cure  .  .       219 

Exuberant  Prepuce     ......     220 

Abundant  and  vitiated  secretion  of  Sebaceous  Matter  .     221 

Congenital  Debility    ......     224 

Ca?e  LVI. — Relaxed  Genital  Organs — Spermatic  Cords  Varicose — Few 
but  debilitating  Nocturnal  Pollutions — ^Opposite  effects  of  Coitus 
— Unsuspected  Diurnal  Pollutions  —  Constant  Headache — Dis- 
ordered Senses — Intellectual  Debility — Hallucination  —  Tonic 
treatment  at  the  age  of  Twenty-one,  followed  by  Recovery  .       224 

Varicocele      .......     227 


ooc 


Case  LVII. — Hypospadias — Impotence — Frequent  Seminal  Discharge  . 

Case  LVIII. — Atrophy  of  one  Testicle  at  the  age  of  Eight — Nocturnal 
and  afterwards  Diurnal  Pollutions — Frequent  desires  of  Micturi- 
tion, &c.  .  .  .  .  .  .  .       230 

Case  LIX. — Lymphatic  Temperament — Incontinence  of  Urine — Neither 
Masturbation  nor  Sexual  Intercourse — More  and  more  frequent 
Nocturnal  Pollutions — Relaxation  of  the  Sphincters  of  the  Anus 
and  Neck  of  the  Bladder— Treatment  unsuccessful         .  .       231 

Case  LX.—  Sickly  Childhood— Extraordinary  Nocturnal  Pollutions  at 
Sixteen — Some  time  after.  Pollutions  during  Defecation — Ejacu- 
lation impossible— Slow  discharges  of  Semen  after  the  subsidence 
of  Erection— Urethra  very  slightly  Sensitive— Prostatic  Surface 
Hard  and  Cartilaginous        .....       232 


CONTENTS. 


XXV 


Symptoms  of  Debility  of  the  Genital  Organs              .             .  233 

Symptoms  affecting  the  Urinary  Organs  during  Childhood      .  237 

Incontinence  of  Urine             .....  237 

Retention  of  Urine      ......  239 

Hereditary  Transmission         .....  240 

Case  LXI. — Blennorrhagia  at  the  age  of  Twenty-one — Pains  in  the  Testi- 
cles— Pollutions  during  Four  Years — Serious  Gastric  and  Cerebral 
Symptoms  occurring  in  Paroxysms — Hereditary  Predisposition — ■ 
Iced  Milk — Cauterization — Acupuncture — Sulphuretted  Baths — 

Recovery    ......                .  240 

Case  LXII. — Nocturnal  and  Diurnal  Pollutions  occurring  in  Three  Bro- 
thers .  .  .  .  .  .  .244 

Congenital  increased  Nervous  Susceptibility   .             .             .  2-15 

Long-continued  Continence     .....  246 

General  Review  of  the  causes  of  Spermatorrhoea         .             .  249 


CHAPTER  XL 


SYMPTOMS  OF  SPERMATORRHCEA. 

Local  Symptoms         ......  251 

Nocturnal  Pollutions  ......  251 

Diurnal  Pollutions      ......  254 

During  Defecation  .....  255 

During  the  Emission  of  Urine     ....  256 

Appearance  of  Spermatic  Urine  ....  256 

Other  Diurnal  Pollutions         .....  258 

Impotence      .......  259 

Diagnosis  of  Spermatic  Urine  ....  259 

Chemical  Analysis       ......  260 

Microscopic  Examination        .....  260 

Spermatozoa  .......  262 

Appearances  on  Making  Water  in  a  Bath        .  .  .  264 

Simplest  mode  of  Detecting  the  presence  of  Spermatozoa  in 

the  Urine  ......  266 


XXVI 


CONTENTS. 


CHAPTER  XIL 


SYMPTOMS  OF  SPERMATORRHCEA — CONTINUED. 

General  Symptoms     ......     268 

Infecundity    .......     268 

Changes  in  the  Characters  of  the  Semen         .  .  .     270 

Fever" *     270 

Symptoms  affecting  the  Digestive  Organs       .  .  .     270 

Symptoms  affecting  Nutrition  ....     274 

Animal  Heat  ......     275 

Symptoms  affecting  Respiration  ....     276 

Symptoms  affecting  the  Circulation    ....     276 

Symptoms  affecting  Innervation  ;  .  .  .     278 

Motih'ty  .  .  .  .  .  .278 

Sensation  ......     279 

Symptoms  affecting  the  special  Senses  .  .  .     280 

Taste 280 

Smell  .  .  .  .  .  .  .281 

Hearing  .......     281 

Sight .281 

Symptoms  affecting  the  Encephalon    ....     284 

Sleep  and  Waking      .  .  .  .  .  .284 

Cephalalgia    .......     285 

Cranial  Congestion     ......     285 

Alteration  of  Character  .....     287 

Hypochondriasis  .  .  .  .  .  .     287 

Memory  .  .  .  .  .  .  .289 

Intellect  .  .  .  .  .  .  .290 

Insanity  .  .  .  .  .  .  .291 

General  and  incomplete  Paralysis  of  the  Insane  .  .     294 

General  character  of  the  Symptoms  of  Spermatorrhoea  .     295 

Effects  of  Masturbation  on  Children  and  Females       .  .     296 

Progress  of  Symptoms  .  .  .  .  .     296 

Spontaneous  Recovery  .....     297 


CONTENTS.  XXVU 


CHAPTER  Xlir. 


TREATMENT  OF  SPERMATORRHEA. 


Pollutions  arising  from  Direct  Causes 

Pollutions  arising  from  Ascarides 

Pollutions  excited  by  Cutaneous  Eruptions     . 

Pollutions  arising  from  altered  or  increased  Secretion  of  the 

Sebaceous  Glands  .... 

Pollutions  depending  on  Stricture  of  the  Urethra 
Treatment  of  the  various  kinds  of  Stricture  . 
Pollutions  arising  from  Hemorrhoids  . 
Pollutions  caused  by  Cicatrices  in  the  neighborhood  of  th 

Anus        ...... 

Pollutions  caused  by  Fissure  of  the  Anus 
Pollutions  produced  by  Constipation  . 


CHAPTER  XIV. 

TREATMENT  OF  SPERMATORRHEA — CONTINUED. 

Pollutions  caused  by  Relaxation  and  Debility 
Pollutions  arising  from  increased  Nervous  Susceptibility 
Acupuncture  ...... 

Pollutions  kept  up  by  Habit   .... 

Pollutions  caused  by  Sleeping  on  the  Back     . 


298 
298 
301 

302 
303 
303 
305 

30G 
306 

307 


309 
313 
315 
316 
316 


CHAPTER  XV. 

TREATMENT  OF  SPERMATORRHCEA — CONTINUED. 

Pollutions  caused  by  Irritation  or  Chronic  Inflammation  .     317 

Diet   ........     318 

Cauterization  ......     319 


XXviii  CONTENTS. 

Action  of  the  Nitrate  of  Silver  ....  323 

Cauterization  in  Chronic  Vesical  Catarrh        .  .  .  324 

Deviation  of  the  Orifices  of  the  Ejaculatory  Canals   .  .  325 


CHAPTER  XVI. 

TREATMENT  OF  SPERMATORRHCEA — CONTINUED. 

Convalescence  ......     326 


ox  THE 

CAUSES,  SYMPTOMS,  AND   TREATMENT 

OF 

SPERMATOERHCEA. 


CHAPTER  I. 

INTRODUCTION. 

Involuntary  discharge  of  the  seminal  fluid  presents  itself  under 
various  conditions,  which  differ  much  in  their  respective  degrees  of 
importance. 

When  it  occurs  spontaneously  during  sleep  in  a  healthj  and  con- 
tinent individual,  it  doubtless  exerts  a  beneficial  influence  on  the  eco- 
nomy, by  freeing  it  from  a  source  of  excitement,  the  prolonged  accu- 
mulation of  which  might  derange  the  animal  functions.  In  these 
cases,  it  has  an  effect  analogous  to  that  produced  by  the  epistaxis, 
common  and  beneficial  during  youth.  But  the  discharge  may  become 
excessive,  or,  from  the  condition  of  the  parts,  it  may  outlive  the  state 
that  excited  it ;  then,  like  repeated  nasal  hemorrhage,  it  gives  rise  to 
inconveniences  proportioned  to  its  frequency,  its  quantity,  and  the 
constitution  of  the  individual.  Involuntary  seminal  emissions  may 
be  caused  by  too  great  excitement  of  the  genital  apparatus,  following 
venereal  excesses  or  masturbation.  A  state  of  irritation  remains  in 
the  spermatic  organs  after  such  excitement,  which  induces  an  increased 
secretion  and  hurried  discharge  of  the  secreted  fluid,  without  com- 
plete erection,  and  almost  without  sensation.  Lastly,  the  relaxation  of 
the  ejaculatory  canals  accompanying  this  state  of  irritation,  may  allow 
the  expulsion  of  the  semen  without  either  erection  or  enjoyment,  and 
this  takes  place  especially  during  defecation  and  the  expulsion  of 
the  urine.  The  transition  between  these  different  stages  of  seminal 
evacuation  is  sometimes  so  insensible,  that  it  is  impossible  for  the 
patient,  or  even  for  the  medical  attendant,  to  specify  its  exact  period. 

Every  extreme  evacuation  of  the  spermatic  secretion,  in  whatever 


34  INTRODUCTION. 

manner  caused,  is  capable  of  producing  the  same  effects  on  the  sys- 
tem. The  different  species  of  spermatorrhoea  need  not  therefore  be 
separated  either  in  theory  or  in  practice. 

Ordinary  nocturnal  emissions  are  easy  of  diagnosis  and  of  cure  ; 
I  shall  therefore  pass  them  over,  and  only  treat  of  those  evacuations 
which  are  sufficiently  serious  to  injure  the  health,  or  which  are  con- 
nected with  discharges  not  ordinarily  perceived. 

I  shall  use  the  expressions  diurnal  and  nocturnal  pollutions^  be- 
cause involuntary  discharge  of  the  spermatic  secretion  certainly 
occurs  during  the  night  without  erection  and  without  pleasurable  sen- 
sations, as  well  as  in  consequence  of  lascivious  dreams  after  sunrise. 
Neology  is  only  to  be  excused  when  used  for  the  prevention  of  errors; 
and  I  think  no  one  will  be  deceived  respecting  the  meaning  of  these 
expressions,  which,  indeed,  are  at  present  generally  understood. 
In  order,  however,  to  avoid  the  repetition  of  many  words,  I  shall 
express,  by  the  term  spermatgrrhcea,  every  excessive  spermatic 
evacuation,  from  whatever  cause  it  may  arise. 

Diurnal  pollutions  are  ,not  always,  as  is  generally  believed,  the 
result  of  venereal  excesses,  or  of  vicious  habits.  Many  other  varied 
causes,  whose  influence  may  be  single,  successive,  or  simultaneous, 
also  give  rise  to  them. 

Some  of  these  causes  are  already  understood,  but  of  many  others, 
the  medical  world  is  completely  ignorant ;  and  these  are  the  most 
dangerous,  because  their  influence  is  the  most  difficult  of  appreciation. 

In  all  sciences  the  study  of  causes  is  the  most  important  and  the 
most  difficult.  This  is  true  of  medicine,  and  especially  of  the  affec- 
tion forming  the  subject  of  this  work  ;  for  it  is  principally  from  the 
cause  of  the  spermatorrhoea,  that  we  learn  its  therapeutic  indications. 
It  is  true  that  we  must  also,  in  each  case,  take  into  account  the  parti- 
cular condition  of  the  genital  organs,  and  the  constitution  of  the  indi- 
vidual ;  but  these  considerations  are  of  little  importance  with  respect 
to  the  treatment  to  be  employed,  and  it  is  especially  in  a  practical 
point  of  view,  that  I  wish  to  consider  this  disease.  In  consequence 
of  not  having  properly  distinguished  its  causes,  explanations,  as  often 
false  as  true,  have  been  published  respecting  spermatorrhoea,  and 
modes  of  treatment  have  been  recommended,  whose  general  applica- 
tion has  been  sometimes  useful,  but  more  often  injurious. 

It  is,  however,  of  great  importance  to  study  attentively  the  symp- 
toms of  involuntary  spermatic  discharges ;  they  are  little  known,  very 
varied,  and  capable  of  simulating  a  host  of  other  affections;  but  their 
character  is  independent  of  the  first  cause  of  the  disease,  and  they 
furnish  few  indications  for  the  regulation  of  its  treatment. 

On  the  other  hand,  the  history  of  this  affection  is  so  much  in  its 
infancy,  that  I  feel  the  necessity  of  proceeding  as  if  I  were  treating 
an  entirely  new  subject.  I  shall,  therefore,  relate  many  single  cases, 
before  I  attempt  to  arrive  at  general  conclusions.  As  these  cases  are 
very  numerous,  I  must  classify  them  according  to  some  arrangement, 
and  I  shall  place  the  causes  first  in  this  classification,  since  they  are 


INTRODUCTION.  35 

the  most  important  part  of  it.  Proceeding  from  the  evident  to  the 
doubtful,  and  from  the  simple  to  the  compound,  I  shall  examine  first 
the  causes  whose  action  is  most  direct  and  undoubted  ;  and  whilst 
studying  the  influence  of  each  cause,  I  shall  bring  forward  the  cases 
in  which  its  action  has  been  energetic,  isolated,  and,  when  possible, 
proved  by  post-mortem  inspection,  and  I  shall  afterwards  cite  cases 
in  which  several  causes  have  acted  successively  or  simultaneously. 

After  having  examined  many  cases  in  this  manner,  I  shall  make  a 
general  resume,  in  the  course  of  which,  I  shall  comment  on  whatever 
relates  to  the  symptoms  of  the  treatment. 

I  shall  also  pay  attention  to  the  analogous  phenomena  which  may 
be  observed  in  the  female. 

I  propose  then  to  consider  this  affection  of  the  genital  organs  in 
all  its  varied  phases  ;  I  shall  pass  rapidly  over  what  is  already 
known ;  I  shall,  on  the  contrary,  insist  on  the  most  remarkable  er- 
rors, and  comment  fully  on  all  that  may  seem  doubtful  or  obscure. 

If  I  were  to  relate  all  the  cases  that  have  come  under  my  notice, 
tiresome  repetitions  would  result :  I  shall,  therefore,  choose  only 
those  which  best  show  the  characteristic  features  of  the  most  import- 
ant distinctions.' 


'  I  have  thought  it  advisable,  on  account  of  the  great  number  and  length  of  these 
cases,  to  select  a  few  of  the  most  striking  only.  In  answer  to  a  communication  from 
me  on  this  subject,  M.  Lallemand  has  favored  me  with  the  following  observation. 
"  As  regards  the  cases,  their  number  may  be  reduced,  now  that  facts  are  being  daily 
multiplied  in  confirmation  of  those  I  have  related ;  it  will  be  sufficient  for  you  to  give 
the  most  characteristic." — [H.  I.  M'D.] 


(    36     ) 


CHAPTER  II. 

INFLAMMATION  OF  THE  SPERMATIC  ORGANS, 

Pathological  Anatomy. 

Inflammation  of  the  organs  for  the  secretion  and  excretion  of 
setnen,  is  the  most  frequent  and  most  active  cause  of  spermator- 
rhoea. The  influence  of  this  cause  may  be  very  easily  conceived, 
and  its  traces  may  be  detected  in  the  organs  after  death  ;  I  shall, 
therefore,  commence  the  subject  by  its  consideration. 

Works  on  pathological  anatomy  have  hitherto  afforded  us  very 
little  information  respecting  this  important  and  delicate  matter  ;  the 
omission  arises  from  several  circumstances. 

Inflammation  of  the  spermatic  organs  does  not  threaten  life  at  its 
commencement ;  when  the  patient  dies  at  an  early  period  of  the 
affection,  it  is  in  consequence  of  some  other  more  serious  disease, 
which  engrosses  the  care  of  the  attendants,  so  that  after  death  ex- 
amination of  the  spermatic  organs  is  neglected. 

When  the  continued  influence  of  this  inflammation  produces 
diurnal  pollutions  sufficiently  serious  to  destroy  life,  the  periods  of 
their  occurrence  are  very  distant ;  the  symptoms  are  insidious,  and 
their  true  cause,  in  many  cases,  is  not  even  suspected.  Whatever 
the  care  taken,  then,  in  examining  the  body,  it  generally  happens 
that  every  part  is  inspected,  except  the  genital  organs  ;  incomplete 
cases  are  thus  published,  which  are  received  with  the  more  con- 
fidence, because  the  dissection  of  the  viscera,  generally,  has  been 
made  with  care. 

The  situation  of  the  prostate  and  seminal  vesicles  is  another  rea- 
son why  their  examination  is  neglected.  In  order  to  inspect  these 
parts  with  the  minute  care  requisite,  it  is  necessary  to  divide  the 
crural  arch  near  its  centre,  to  remove  the  abductor  muscles  of  the 
thighs,  to  cut  through  the  horizontal  rami  of  the  pubes,  and  the 
rami  of  the  ischia,  so  as  to  remove  the  testicles,  the  vasa  deferentia, 
the  rectum,  and  the  perineum  undisturbed. 

It  is  by  this  means  only  that  we  can  obtain  a  good  view  of  the 
organs  situated  in  the  lower  part  of  the  pelvis,  examine  their  rela- 
tions with  care,  or  observe  their  color,  consistence  and  dimensions — 
circumstances  requiring  attentive  study — since  serious  symptoms  may 
follow  almost  imperceptible  lesions.     Thus,  for  instance,  the  orifices 


INFLAMMATION    OF    THE    SPERMATIC    ORGANS.  37 

of  the  ejaculatory  ducts  may  have  been  rendered  uneven  by  some 
sliglit  ulceration ;  their  form  may  have  been  altered,  or  their  size  in- 
creased, of  which  I  have  met  with  several  cases ;  and  we  can  easily 
conceive  the  consequences  which  may  result  from  even  the  partial 
destruction  of  their  little  sphincter  muscles.  The  color,  firmness, 
and  exact  size  of  these  canals  also  furnish  information  of  much  im- 
portance. 

The  examination  of  all  these  parts  requires  considerable  time,  pa- 
tience, and  skill;  it  is  necessary  to  inspect  them  thoroughly,  in  order 
to  appreciate  all  changes  affecting  them,  and  this  is  impossible  if  the 
removal  of  that  portion  of  the  pelvis,  to  which  they  are  attached,  be 
omitted.  Thus  the  section  I  have  described  becomes  in  a  measure 
indispensable;  nevertheless,  in  general  practice  it  is  never  had  recourse 
to,  except  for  the  purpose  of  examining  some  rare  affection  of  the 
bladder  or  prostate.  In  order  to  understand,  thoroughly,  the  condi- 
tions of  these  parts  when  diseased,  it  is  necessary,  also,  to  have  seen 
them  very  frequently  while  healthy :  this  is  neglected  even  by  men 
who  devote  themselves  specially  to  the  study  of  pathological  anatomy. 
On  this  account  I  shall  illustrate  their  pathological  changes  by  some 
cases  which  would  under  other  circumstances  be  devoid  of  interest. 


CASE  I. 

Blennorrhagia — Diurnal  pollutions — Hj/pochondriasis —  Chronic  affection  of 
the  Brain  and  its  Membranes — Death. 

Autopsy. — Right  kidney  in  a,  state  of  suppuration — Prostate  nearly  de- 
stroyed— EJacuIatory  ducts  ulcerated — Seminal  vesicles  altered.  Nothing 
remarkable  in  the  other  organs. 

In  the  month  of  January,  1824,  I  was  requested  to  see  M.  De  S , 

affected  wish  symptoms  of  cerebral  congestion,  from  which  he  had  suffered 
for  some  time.     During  several  consultations  I  gathered  the  following  facts. 

M.  De  S was  born  in  Switzerland,  of  healthy  parents,  and  his  father 

died  suddenly  of  affection  of  the  brain.     M.  De  S ,  possessing  a  strong 

constitution  and  an  active  mind,  received  an  excellent  education,  and  at  an 
early  age  turned  his  attention  to  the  study  of  philosophy  and  metaphysics; 
he  afterwards  studied  moral  philosophy  and  politics. 

After  having  spent  some  years  in  Paris  pursuing  his  favorite  subjects, 
he  was  obliged  to  undertake  the  management  of  a  manufactory,  and  to  at- 
tend to  details  which  wounded  his  pride.  He  became,  by  degrees,  peevish 
and  capricious — passed,  without  apparent  cause,  from  an  extravagant  gaiety 
to  a  profound  melancholy — was  irritated  by  the  slightest  contradiction — 
showed  no  pleasure  at  fortunate  events — and  gave  way  to  anger  on  improper 
occasions:  at  length  he  appeared  to  feel  disgust  and  fatigue  at  correspondence 
or  mental  exertion. 

At  this  period  he  married,  and  Dr.  Butini,  of  Geneva,  his  medical  attend- 
ant and  friend,  wrote  respecting  him  as  follows : — 

"  With  this  marriage  the  most  happy  period  of  his  existence  seemed  to 


38  INFLAMMATION    OF    THE 

commence  ;  but  soon  the  germs  of  the  disease,  which  so  many  causes  bad 
contributed  to  produce,  became  rapidly  developed.     It  was  perceived  that 

]VI.  De  S wrote  slowly  and  with  difficulty,  and  his  style  presented  signs 

of  the  decay  of  his  faculties;  he  stammered  and  expressed  his  ideas  very  im- 
perfectly ;  he  experienced,  also,  at  times,  attacks  of  vertigo,  so  severe  as  to 
make  him  fall,  without,  however,  losing  sensibility,  or  being  attacked  by 
convulsions." 

One  day  an  attack  which  frightened  the  patient  seriously,  and  left  a  deep 
impression  on  his  family,  came  on  whilst  writing  an  ordinary  letter.  His 
medical  attendants  attributed  his  attack,  which  left  a  weakness  of  the  right 
side  of  the  body,  to  apoplexy.  Twenty  leeches  were  applied  to  the  anus, 
and  the  danger  seemed  at  an  end. 

Similar  attacks,  however,  occurred  at  Geneva  and  Montpellier,  and  seve- 
ral distinguished  practitioners  were  consulted:  some  of  these,  struck  by  the 
misanthropic  irritability  of  the  patient,  and  his  solitary  habits,  regarded  the 
affection  as  purely  hypochondriacal  or  nervous;  others,  taking  into  consider- 
ation his  digestive  disorder,  considered  it  an  affection  of  the  liver;  but  the 
greater  number  were  of  opinion  that  there  existed  a  chronic  affection  of  the 
brain,  such  as  encephalitis,  or  chronic  meningitis,  arising  from  hereditary 
predisposition.     This  last  opinion  was  held  by  Dr.  Builly,  (of  Blois.) 

At  all  these  consultations,  the  necessity  of  abstaining  from  serious  occu- 
pation, the  utility  of  travelling — of  various  amusements,  and  of  a  strict  re- 
gimen— and  the  importance  of  free  evacuations  from  the  bowels  by  means 
of  purgatives  and  injections,  were  agreed  on.  Many  of  the  practitioners 
recommended  the  frequent  application  of  leeches  to  the  anus,  with  milk 
diet,  &c. ;  others  thought  that  assafojtida,  baths,  and  camphor,  were  indi- 
cated. 

None  of  these  modes  of  treatment  produced  any  considerable  amendment; 
the  leeches  weakened  the  patient,  and  the  milk  diet  disordered  his  stomach. 
His  constipation  continued.     Cold  plunge  baths,  and  cold  affusion  to  the 

head,  relieved  the  insupportable  spasms  M.  De  S experienced  in  his  legs 

and  face  :  the  waters  of  Aix,  in  Savoy,  and  the  use  of  douches  also  appeared 
to  produce  some  improvement. 

Still  M.  De  S became  more  irritable,  and  at  the  same  time  more 

apathetic.  His  attacks  were  more  frequent  and  more  violent,  and  he  mani- 
fested greater  indifference  towards  the  persons  and  things  he  had  before  been 
partial  to.  The  weakness  of  his  limbs  increased  to  such  an  extent  that  he 
frequently  fell,  even  on  the  most  level  ground.  His  nights  were  restless, 
his  sleep  very  light  and  often  interrupted  by  nervous  tremors,  or  acute 
pains  accompanied  with  cramp.  The  cerebral  congestion  increased,  and  the 
imminent  fear  of  apoplexy  rendered  leeches  to  the  anus,  venesection  in  the 
foot,  tartar-emetic  ointment,  blisters,  mustard  pediluvia,  and  the  application 
of  ice  to  the  head,  necessary. 

Notwithstanding  the  employment  of  these  energetic  measures,  another 
violent  attack  of  congestion  occurred.  I  was  summoned  on  this  occasion, 
and  I  found  the  patient  restless,  agitated,  and  incapable  of  remaining  two 
minutes  in  the  same  place ;  his  face  was  red,  his  eyes  projecting,  injected, 
and  fixed;  his  physiognomy  expressed  extreme  dread;  his  walk  was  uncer- 
tain, his  legs  bending  under  the  weight  of  his  body ;  his  skin  cold,  and  his 
pulse  small  and  slow. 

The  last  circumstance  attracted  my  attention,  and  I  also  recommended 
the  application  of  leeches  to  the  anus.     M.  De  S immediately  threw 


SPERMATIC    ORGANS.  39 

himself  into  a  violent  passion,  and  asserted  that  leeches  had  always  weak- 
ened him  without  giviny  him  any  relief.  I  was  too  much  afraid  of  the  oc- 
currence of  apoplexy  to  pay  attention  to  this  assertion ;  and  I  succeeded  in 
obtaining  the  application  of  six  leeches. 

The  next  day  I  found  the  patient  very  pale,  and  so  weak  that  he  was  un- 
able to  walk — a  source  of  much  annoyance  to  him,  as  he  manifested  a  con- 
stant desire  for  motion.  An  oedematous  swelling  of  the  parotid  gland  and 
of  the  right  cheek  followed,  which  was  succeeded,  a  few  days  after,  by  a 
similar  state  of  the  left  leg  and  foot. 

Sleep  had  become  indispensable,  and  the  patient  was  much  reduced  from 
the  want  of  it;  he  told  me,  with  tears  in  his  eyes,  that  he  had  lost  his  appe- 
tite, and  could  no  longer  relieve  his  bowels.  I  also  learned  that  he  was  ha- 
bitually costive  and  flatulent;  that  he  often  had  recourse  to  injections  and 
purgatives  in  order  to  relieve  his  obstinate  constipation ;  and,  lastly,  that  his 
walks,  and  the  evacuation  of  his  bowels  had  lately  become  the  sole  objects  of 
his  thoughts  and  conversation. 

Having  observed  analogous  symptoms  in  almost  every  person  affected  by 
diurnal  pollutions,  I  made  further  inquiries  respecting  the  attack,  in  which  it 
was  supposed  that  the  right  side  had  been  paralyzed,  and  I  was  soon  con- 
vinced that  the  intellectual  powers  had  been  wanting,  and  not  the  power  in 
the  hand  which  held  the  pen  :  both  sides  of  the  body  had,  in  fact,  retained 
an  equal  degree  of  strength. 

Struck  by  a  remark  of  Dr.  Butini's  respecting  the  progress  of  the  disease 

soon  after  marriage,  I  made  inquiries  of  Mme.  De  S ,  and  learned  that 

the  character  of  her  husband  had  become  so  uncertain,  irritable,  and  tor- 
menting, that  his  friends  thought  he  must  be  unhappy  in  his  marriage.  I 
then  suspected  that  the  origin  of  the  patient's  disease  had  been  mistaken, 
and  I  requested  that  his  urine  might  be  kept  for  my  inspection.  The  ap- 
pearance of  the  urine  was  suflBcient  to  convince  me  that  my  suspicions  were 
well  founded ;  it  was  opaque,  thick,  of  a  fetid  and  nauseous  odor,  resembling 
that  of  water  in  which  anatomical  specimens  have  been  macerated.  By 
pouring  it  off  slowly,  I  obtained  a  flocculent  cloud,  like  a  very  thick  decoc- 
tion of  barley ;  a  glairy,  ropy,  greenish  matter  remained,  strongly  adherent 
to  the  bottom  of  the  vessel,  and  thick  globules  of  a  yellowish  white  color, 
non-adherent,  like  drops  of  pus,  were  mixed  with  this  deposit.  I  was  there- 
fore convinced  that  spermatorrhoea  existed,  together  with  chronic  inflamma- 
tion of  the  prostate  and  suppuration  in  the  kidneys. 

Notwithstanding  the  state  of  M.  De  S 's  intellect,  I  was  able  at  a 

favorable  moment  to  obtain  further  information.  At  the  age  of  sixteen  he 
had  contracted  blennorrhagia;  this  he  carefully  concealed,  and  succeeded  in 
curing  by  the  use  of  refrigerant  drinks.  The  following  year  the  blennor- 
rhagia returned,  and  was  removed  by  astringents.  Two  years  afterwards, 
from  drinking  freely  of  beer  when  heated,  the  discharge  again  appeared,  and 
after  some  time  it  again  returned,  from  the  effects  of  horse  exercise.     Since 

that  time,  M.  De  S had  felt  little   sexual  desire,  and   had  abstained 

'  from  intercourse  without  regret.  Ejaculation  during  coitus  had  always  been 
very  rapid.  Fully  convinced  by  combining  all  these  circumstances,  I  ex- 
plained to  M.  De  S the  nature  of  his  disease,  and  he  promised  me  to 

observe  carefully. 

The  next  day  he  called  me  aside,  and  told  me  that  the  last  drops  of  urine 
were  viscid,  and  that  during  an  evacuation  of  the  bowels,  he  had  passed  a 
sufficient  quantity  of  a  similar  matter  to  fill  the  palm  of  his  hand. 


40  INFLAMMATION    OF    THE 

Eight  days  after,  another  attack  of  cerebral  congestion  occurred,  fol- 
lowed by  stertorous  breathing,  cold  skin,  and  an  inappreciable  pulse ;  the 
patieut  fell  into  a  kind  of  syncope,  of  which  he  died  on  the  1st  of  March, 

1824. 

Post-mortem  inspection,  twenty-six  hours  after  death. — The 
general  emaciation  of  the  body  was  extreme. 

JJead. — Between  the  dura  mater  and  the  arachnoid  several  bubbles  of 
air  appeared,  mixed  with  a  viscid  serosity;  the  vessels  of  the  pia  mater 
were  sli<Thtly  injected;  the  arachnoid  was  a  little  opaque  near  the  falx, 
but  neither  thickened  nor  granular ;  two  or  three  spoonfuls  of  limpid  se- 
rum were  found  in  the  ventricles,  without  any  apparent  alteration  in  their 
serous  lining;  the  brain  was  slightly  injected  and  soft  throughout,  but  with- 
out appreciable  alteration  in  any  one  particular  part;  the  cerebellum,  also, 
was  very  soft,  of  natural  size,  neither  more  nor  less  injected  than  the  brain, 
and  without  any  particular  alteration.  Three  or  four  spoonfuls  of  serum 
were  found  at  the  base  of  the  brain  and  commencemerat  of  the  vertebral 
canal. 

Chest. — Pleura  pulraonalis  everywhere  adherent  by  a  dense  cellular  tis- 
sue to  the  pleura  costalis ;  lungs  crepitant  and  pale,  except  at  the  posterior 
part ;  heart  of  the  ordinary  size,  and  firm. 

Abdomen,  tympanitic,  green,  and  exhaling  a  very  fetid  smell ;  liver  of 
natural  color  and  very  firm;  a  spoonful  of  bile  in  the  gall-bladder;  spleen 
small  and  of  a  violet  color;  stomach  distended  by  gas;  mucous  membrane 
thin,  soft,  and  of  a  brownish-gray  color;  small  and  large  intestines  equally 
distended  by  gas,  pale,  and  thin  in  their  structure,  containing  a  small  quan- 
tity of  brown,  excessively  offensive  liquid,  fgecal  matter. 

Left  Kidney  of  the  ordinary  size,  of  a  healthy  red,  and  very  firm. 

Riyht  Kidney  a  third  larger  than  natural,  adherent  by  a  dense,  resistant 
cellular  tissue  to  the  surrounding  structures;  containing  in  its  parenchyma 
about  forty  little  abscesses,  varying  from  the  size  of  a  pea  to  that  of  a  nut, 
some  of  recent  formation,  and  without  cysts,  others  old  and  encysted,  all  con- 
taining thick  and  creamy  pus;  the  structure  of  the  kidney  reduced  in  four- 
fifths  of  its  extent  to  a  dense  coriaceous  membrane,  full  of  cloacce  ;  the  lining 
membrane  of  its  pelvis  red  and  villous  ;  the  ureter  thin,  distended,  brownish, 
and  much  injected  on  its  mucous  surface. 

Bladder  rising  as  high  as  the  umbilicus,  and  containing  two  pints  of  trans- 
parent urine.  Its  parietes  thin ;  the  muscular  fibres  weak  and  scattered  ; 
mucous  membrane  rose-colored  and  slightly  injected,  but  thin  and  scarcely 
altered  in  appearance.* 

Prostate  projecting  three  or  four  lines  behind  the  neck  of  the  bladder, 
over  about  an  inch  and  a  half  in  superficial  extent.  In  the  Trigone  Vesicle 
there  was  an  effusion  of  albuminous  matter,  half  a  line  in  thickness  and 
about  two  inches  in  extent,  uniting  the  seminal  vesicles  to  the  anterior  wall 
of  the  rectum. 

The  Left  Seminal  Vesicle  small  and  brown,  but  in  its  normal  position. 

The  Right  separated  from  the  corresponding  A'as  deferens,  folded  on  the 
posterior  border  of  the  prostate,  atrophied  and  surrounded  by  a  very  dense 
fibrous  cellular  tissue,  which  was  very  difficult  of  dissection. 


•  In  order  to  examine  the  genital  organs  with  greater  care,  I  removed  the  parts 
■with  the  rectum,  by  means  of  the  section  before  described. 


SPERMATIC    ORGANS,  41 

The  Prostate  double  its  normal  size,  and  projecting  into  the  rectum ; 
hard  on  the  sides  of  the  neck  of  the  bladder,  soft  in  the  centre.  Its  fibrous 
envelope  having  been  divided  with  a  bistoury,  an  opaque,  thick,  ropy, 
elastic  matter  escaped,  like  pus  in  color,  and  the  mucus  of  the  nostrils  in 
consistence.  There  was  a  cavity  occupying  the  whole  of  the  anterior  and 
middle  parts  of  the  prostate,  about  fifteen  lines  in  size  in  every  direction, 
when  the  purulent  matter  had  been  removed  ;  the  gelatinous  mass  was 
observed  to  divide  into  a  number  of  filaments  which  became  impacted  in 
numerous  small  foramina;  the  canal  of  the  urethra  being  closed,  these 
filaments  came  out  by  the  openings  of  the  mucous  follicles  of  the  prostate. 
When  this  cavity  was  emptied  it  became  evident  that  the  two  inferior 
thirds  of  the  prostatic  part  of  the  urethral  mucous  membrane  had  been 
detached  and  had  covered  the  cavity  in  the  prostate  in  the  same  manner 
that  the  cribriform  lamella  of  the  ethmoid  bone  covers  the  nasal  fossae  in  the 
dried  skull. 

The  openings  of  the  Ejacxdatory  Ducts,  in  place  of  being  circular  and 
nipple-shaped,  formed  a  long  slit,  which  was  ulcerated,  especially  on  the 
side  towards  the  bladder;  two  probes  of  considerable  size  introduced 
through  the  vasa  deferentia  passed  easily  through  these  openings.  The 
ejaculatory  ducts  were  long  and  thin,  as  though  dissected,  and  formed  part 
of  the  superior  wall  of  the  cavity  in  the  prostate.  The  posterior  border  of 
the  prostate  was  not  destroyed,  but  was  pale,  soft,  and  easily  torn,  like  all 
the  parts  in  the  neighborhood  of  the  principal  abscess. 

The  Urethra  presented  no  remarkable  appearances. 

The  Testicles  were  small,  flaccid,  and  pale. 

I  leave  this  case  just  as  I  wrote  it  when  under  impressions  formed 
at  the  time,  because  its  recital  is  well  fitted  to  show  those  serious 
errors  in  diagnosis  which  are  much  more  common  than  might  have 
been  suspected. 

Now  that  we  have  seen  the  move  obscure  parts  of  this  case  cleared 
up  by  degrees,  let  us  consider  the  chronological  order  of  the  facts  : — 

A  urethral  discharge,  badly  treated  in  the  beginning,  reappeared 
from  very  slight  causes,  whose  action,  however,  was  easily  appre- 
ciable. The  follicles  of  the  prostate,  from  repeated  attacks  of  in- 
flammation, became  disorganized ;  the  ejaculatory  ducts  were  laid 
bare,  and  their  orifices  became  ulcerated  ;  the  inflammation  extended 
to  the  seminal  vesicles,  and  the  peritoneum  adjoining. 

Soon  after,  a  new  train  of  symptoms  set  in,  which  became  much 
aggravated  after  the  patient's  marriage,  in  consequence  of  the  unac- 
customed exercise  of  the  disordered  organs.  Ejaculation  was  rapid, 
because  the  ejaculatory  ducts  were  in  a  state  of  irritation.  The 
erections  were  incomplete,  and  at  length  ceased  altogether,  because 
the  semen  was  habitually  expelled  as  soon  as  secreted.  This  dis- 
charge was  considerable,  for  the  testicles  shared  the  irritation  of  the 
other  parts.  During  all  this  time  inflammation  was  creeping  along 
the  urinary  apparatus,  and  ended  by  destroying  the  right  kidney. 
Hence  the  symptoms  observed  previous  to  death ;  hence  the  very 
remarkable  appearance  of  the  urine,  an  excretion  to  whose  changes 
suflScient  importance  is  not  attached  at  the  present  day,  from  its  exa- 


42  INFLAMMATION    OF    THE 

mination  having  been  once  rendered  ridiculous  through  the  preten- 
sions of  quacks. 

CASE  II. 

Blennorrhagia — Spermatorrhoea — Hi/pochondriasis — Frequent  attacks  of 
cerebral  confjestion — Death. 

Autopsy. — Suppuration  in  the  seminal  vesicles — Ossific  deposit  in  the  vasa 
de/erenfia — Cystitis — Phlebitis — Old  adhesions  of  the  arachnoid  and 
pleurse — Abscesses  in  the  muscles  of  the  neck  and  shoulders. 

On  the  25th  of  September,  1825,  Professor  Brousonnet  granted  me  the 
examination  of  one  of  his  patients  who  was  supposed  to  have  died  from 
cerebral  hemorrhage.  Before  commencing  the  post-mortem  I  learnt  the  fol- 
lowing particulars : — 

Francis  Maurice,  aged  seventy-three  years,  formerly  a  soldier,  had  com- 
plained for  some  time  of  weakness  in  his  legs ;  he  staggered  whilst  walking 
as  if  he  suffered  from  giddiness,  and  he  would  often  have  fallen  if  he  had 
not  been  assisted.  Occasionally  he  had  attacks  of  congestion  in  his  head ; 
his  face  became  red,  he  lost  his  senses,  and  experienced  very  varying  spas- 
modic symptoms.  After  these  his  face  became  pale,  and  fainting  occurred. 
These  attacks  had  been  treated  by  bleeding,  derivatives,  antispasmodics,  and 
leeches. 

At  length,  on  the  22d  of  December,  a  violent  attack  of  congestion  in  the 
head  occurred  ;  his  face  became  purple,  and  the  next  day  he  died. 

These  symptoms  seemed  to  indicate  a  chronic  affection  of  the  brain  or  its 
membranes,  producing  attacks  of  congestion,  the  last  of  which  terminated 
in  apoplexy.  On  inquiry  I  could  not  learn  which  side  of  the  body  had 
been  paralyzed ;  but  it  seemed  certain  that  no  distortion  of  the  face  had 
ever  existed.  This  circumstance  made  me  suspect  that  the  paralytic  symp- 
toms had  always  been  general. 

The  cause  of  the  disease  was  attributed  to  some  hidden  care.  The  pa- 
tient had  spoken  little,  and  always  presented  a  sad  and  silent  appearance  : 
he  had  complained  of  a  host  of  different  diseases,  the  greater  number  of 
which  seemed  imaginary,  or,  at  least,  much  exaggerated.  He  complained 
of  pain  about  the  occiput,  the  neck,  and  the  back ;  colic,  distention  of  the 
lower  part  of  his  belly,  and  borborygmi  affected  him  frequently.  Notwith- 
standing his  weakness  he  had  a  constant  desire  for  motion  :  he  could  not 
remain  quiet  in  bed,  and  often  had  recourse  to  the  night-stool.  lie  had  an 
irritable  manner ;  he  tormented  the  nurses  and  snubbed  the  pupils,  and  was 
generally  looked  upon  by  the  latter  as  a  hypochondriac. 

I  learnt  also  that  he  had  experienced  several  attacks  of  retention  of  urine, 
and  I  recollected  having  introduced  a  catheter  for  him  a  few  days  before 
his  death. 

I  suspected,  therefore,  that  the  symptoms  he  had  manifested  arose  from 
unperceived  spermatorrhoea. 

The  following  are  the  results  of  the  inspection  of  the  body  : — 

i/eafZ.— Cerebrum  and  cerebellum  slightly  softened  throughout,  but  not 
more  so  in  one  part  than  in  another;  the  cerebral  substance  slightly,  but 
equally,  injected,  especially  in  the  posterior  lobes  ;  several  old  cellular  adhe- 
sions, five  or  six  lines  in  extent,  in  the  inferior  occipital  fossae,  intimately 
uniting  the  corresponding  surfaces  of  the  arachnoid;  the  cerebellum  equally 


SPERMATIC    ORGANS.  43 

adherent  to  the  pia  matter  in  the  same  situation,  and  incapable  of  being  de- 
tached without  injury  to  its  structure.  In  the  other  parts  of  the  interior  of 
the  cranium  there  was  not  the  least  local  change  that  could  be  considered  a 
result  of  recent  disease. 

Thorax. — Lungs  healthy;  a  few  old  adhesions  of  the  pleuras  on  both 
sides;  heart  flaccid,  of  the  color  of  wine  lees,  and  easily  torn  ;  the  principal 
veins  without  firmness,  and  of  a  dark  violet  color;  the  iliac  and  crural  veins 
presented  the  same  conditions. 

Abdomen. — The  mucous  membrane  of  the  stomach  slightly  injected ;  the 
small  intestines  in  much  the  same  state ;  nothing  remarkable  in  the  other 
abdominal  organs ;  the  kidneys  and  ureters  healthy. 

Pelvis. — The  bladder,  which  contained  a  large  quantity  of  muddy  urine, 
was  united  to  the  rectum  by  cellular  adhesions ;  its  mucous  membrane  was 
of  a  dark  red,  highly  injected,  and  covered  by  small  ecchymoses,  from  ex- 
travasation of  blood  in  its  structure ;  the  prostate  was  of  its  natural  size  and 
firmness. 

The  Seminal  Vesicles  were  much  dilated,  their  parietes  were  very  thick 
and  dense,  and  they  presented  no  markings  or  inequalities.  These  organs 
were  attached  by  strong  and  much  injected  cellular  tissue  to  the  neighbor- 
ing parts,  and  each  of  them  contained  about  a  spoonful  of  thick  yellowish 
pus  enclosed  in  three  or  four  cavities  communicating  with  each  other  and  . 
with  the  ejaculatory  ducts.  The  inner  surface  of  these  abscesses  was  un- 
even, rugous,  and  lined  by  a  sort  of  false  membrane  formed  by  a  layer  of 
thickened  pus. 

The  Vasa  Defereniia  were  tortuous,  and  completely  ossified  for  the  extent 
of  about  three  inches,  but  not  obliterated.  They  contained  a  slightly  viscid 
fluid. 

The  mucous  membrane  of  the  urethra  was  much  injected,  especially  from 
the  bulb  as  far  as  the  bladder;  the  mucous  follicles  much  developed.  The 
neck  of  the  bladder  was  thickened,  of  a  reddish  brown  color,  without  tena- 
city, and  fissured  by  several  recent  lacerations. 

Some  days  after,  the  pupils,  who  were  dissecting  the  muscles  of  this  sub- 
ject, told  me  that  they  had  found  the  subscapularis,  and  the  supra-  and  infra- 
spinatus muscles  on  both  sides,  as  well  as  several  muscles  of  the  neck,  in  a 
state  of  suppuration. 

Some  time  after  I  succeeded  in  learning  the  following  facts. 

Maurice  whilst  in  service  at  the  age  of  twenty-three  years  contracted  a 
violent  blennorrhagia  accompanied  by  orchitis  and  inflammation  of  the  spongy 
tissue  of  the  urethra,  which  he  neglected  after  the  relief  of  the  most  urgent 
symptoms.  His  character,  previously  very  gay,  now  changed  by  degrees ; 
he  experienced  attacks  of  profound  melancholy,  during  which  he  imagined 
that  every  one  disliked  hira  ;  when  these  attacks  were  over  he  gave  himself 
up  to  dissipation;  he  drank  freely,  but  when  no  longer  excited  he  relapsed 
into  melancholy,  and  often  complained  of  pains  in  his  head  towards  the  oc- 
ciput. 

At  first  he  experienced  nocturnal  pollutions,  and  soon  after  he  perceived 
that  in  evacuating  his  bowels,  especially  when  costive,  he  sometimes  had  a 
spermatic  discharge.  By  degrees  his  digestion  became  much  disordered, 
constipation  became  habitual,  and  the  spermatic  discharges  at  stool  in- 
creased. He  reformed  and  gave  up  drinking :  his  health  was,  however, 
ruined  ;  he  took  cold  easily,  and  suffered  from  pain  in  his  side  and  frequent 
pains  in  his  limbs  and  loins;  he  was  constantly  tormented  by  flatulence, 


44  INFLAMMATION    OF    THE 

colic,  and  diarrhoea  or  obstinate  constipation.  His  legs  were  weak,  and  his 
body  was  frequently  affected  with  tremors ;  yet  be  could  not  remain  in  bed, 
he  was  tormented  night  and  day  by  a  constant  desire  for  motion,  and  being 
very  weak  he  frequently  fell. 

After  some  time  he  had  difficulty  in  supporting  his  head,  and  he  complained 
of  a  constant  pain  in  his  neck  and  shoulders,  accompanied  by  tenderness  in 
the  vertebral  column.  The  evacuation  of  urine,  previously  irregular  and  dif^ 
ficult,  now  became  often  impossible  without  the  aid  of  a  catheter. 

Latterly,  he  became  subject  to  frequent  attacks  of  cerebral  congestion, 
during  wliich  his  face  was  purple ;  he  was  insensible,  convulsed,  and  appeared 
to  be  threatened  with  an  attack  of  apoplexy.  The  practitioner,  called  under 
these  circumstances,  never  failed  either  to  bleed  from  the  arm,  or  to  apply 
leeches,  and  as  the  attack  did  not  last  long,  he  attributed  its  relief  to  the  ab- 
straction of  blood.  Immediately  afterwards,  even  when  bleeding  had  not 
been  practised,  the  patient  remained  exceedingly  pale ;  and  at  the  close  of 
one  of  these  attacks  he  died. 

The  same  causes  produced  the  same  effects  in  this,  as  in  the  pre- 
ceding case  ;  the  same  sym.ptoms  led  to  the  same  errors  in  diagnosis  : 
it  was  just  as  difficult  to  discover  the  truth,  and  the  same  appear- 
ances were  found  after  death.  Cases  of  this  nature  are  not  then  so 
rare  as  might  have  been  expected. 

Supposing  that  in  these  two  cases,  we  had  proceeded  to  examine 
the  bodies,  with  the  pre-convictions  arising  from  an  observation  of 
the  symptoms  ;  it  is  clear  we  should  have  found  nothing  in  the  cranial 
cavity,  which  would  have  accounted  for  the  cerebral  symptoms,  for  a 
general  and  uniform  softness  of  the  cerebral  matter  is  observed  after 
all  chronic  diseases,  especially  when  decomposition  has  made  any 
progress  ;  it  is  evident  also  that  we  should  have  found  nothing  more 
satisfactory  in  the  other  viscera :  who  knows,  then,  to  how  many 
errors  these  observations  might  not  have  given  rise  ? 

Among  the  cases  cited  by  the  believers  in  nervous  apojjlexy,  and 
special  spasmodic  affections,  I  am  convinced  that  a  great  number  arise 
from  spermatorrhoea ;  but,  from  the  non-examination  of  the  genital 
organs,  it  has  been  impossible  hitherto  to  prove  the  correctness  of 
this  opinion.  I  trust  that  soon  all  practitioners  will  be  able  to  avoid 
such  errors.  But  let  us  reconsider  the  case  of  Maurice  : — at  the  age 
of  twenty-three  he  had  urethritis,  accompanied  by  chordee  and  or- 
chitis. As  soon  as  the  worst  symptoms  were  relieved,  he  resumed 
his  old  habits,  and  gave  himself  up  to  excesses  of  all  kinds.  By 
degrees  his  health  failed  under  the  influence  of  nocturnal,  and  af- 
terwards of  diurnal  pollutions;  he  became  hypochondriacal,  and  not- 
withstanding his  forced  abstemiousness,  he  at  length  died  in  the  same 
state  as  M.  De  S . 

Why  did  this  patient  resist  the  action  of  the  disease  longer  than 
the  first  ?  Because  the  alterations  were  much  less  serious,  and  even 
the  state  of  the  pus  found  in  the  prostate  seemed  to  announce  that 
the  inflammation  had  taken  on  an  acute  character  only  during  the 
last  stage  of  the  disease. 


SPEKMATIC    OEGAlsrS.  45 

Can  diurnal  pollutions,  sufficient  to  destroy  life,  exist  at  the  age  of 
seventy-three  years  ?  Undoubtedly  they  can,  since  the  vasa  defe- 
rentia  still  contain,  at  this  age,  a  viscid  secretion,  consisting  of  badly 
forir.ed  semen  ;  besides,  the  patient  had  told  his  friends,  shortly  before 
his  death,  that  in  going  to  stool  he  had  passed  semen  in  the  palm  of 
his  hand. 

I  have  before  said  that  Maurice  passed  for  a  hypochondriac,  and 
that  his  diseases  -^vere  considered  imaginary,  or  at  least  very  much 
exaggerated  ;  nevertheless,  we  found,  in  various  organs,  recent  and 
old  changes,  to  which  we  must  refer  his  complaints. 

By  degrees,  as  his  health  broke  up,  he  became  more  easily  affected  ; 
he  complained  of  pains  in  his  side — his  lungs  were  attached  to  the 
walls  of  the  chest  by  cellular  adhesions  ;  he  often  complained  of  pains 
in  the  head,  fixed  towards  the  occiput — the  cerebellum  was  found  ad- 
herent to  the  meninges  at  several  spots,  at  the  same  time  that  the 
membranes  were  attached  to  each  other :  latterly,  he  complained  of 
constant  pains  in  the  neck  and  shoulders — the  subscapularis  and  su- 
pra- and  infra-spinatus  muscles  of  both  sides,  together  with  several 
muscles  of  the  neck,  were  found  in  a  state  of  suppuration :  the  pa- 
tient was  subject  to  attacks  of  retention  of  urine — the  neck  of  the 
bladder,  together  with  the  urethra  and  vesical  mucous  membrane, 
were  thickened,  and  of  a  brownish  red  color. 

I  ought  to  add,  that  the  principal  abdominal,  and  even  the  femoral 
veins,  were  softened,  and  of  a  violet  hue,  and  presented  traces  of 
phlebitis. 

We  see,  therefore,  that  most  of  the  disorders  of  which  Maurice 
complained  depended  on  so  many  really  existing  local  inflamma- 
tions. 

I  know  that  many  of  the  symptoms  experienced  by  patients  af- 
fected with  spermatorrhoea  are  purely  nervous,  and  that  we  find  often 
after  death,  no  trace  of  alteration  in  the  organs  which  have  been  sup- 
posed to  be  diseased ;  but  I  also  know  bow  the  majority  of  post- 
mortem examinations  are  conducted. 

We  forget  that  the  slow  and  progressive  weakening  of  the  consti- 
tution, following  disordered  digestion,  causes  an  increased  nervous 
susceptibility  in  hypochondriacs;  and  that  a  less  energetic  resistance 
of  the  different  organs  to  the  action  of  causes  capable  of  altering 
their  health  also  results  from  it ;  hypochondriacal  patients  are  thus 
much  more  liable  to  every  disease,  at  the  same  time  that  they  suffer 
more  from  the  diseases  affecting  them. 

A  few  words  more  on  the  other  lesions :  the  vasa  deferentia  were 
ossified  in  several  points :  this  ossific  deposit  was  not  the  effect  of 
age,  as  might  be  supposed,  for  I  have  met  with  it  under  similar  cir- 
cumstances in  very  young  subjects  ;  it  must,  therefore,  be  attributed 
to  old  standing  inflammation. 

In  the  orchitis  that  follows  blennorrhagia,  the  inflammation  extends 
from  the  mucous  membrane  of  the  urethra  to  the  testicles,  by  the 
ejaculatory  ducts,  seminal  vesicles,  and  vasa  deferentia ;  the  latter 


46  INFLAMMATION    OF*  THE 

are  almost  cartilaginous  in  their  normal  conditions ;  in  chronic  in- 
flammation, therefore,  thej  may  easily  become  encrusted  with  phos- 
phate of  lime. 

The  neck  of  the  bladder  was  fissured  by  several  recent  splits. 
When  the  internes  requested  me  to  catheterize  this  patient,  it  was  be- 
cause they  had  been  unable  to  enter  the  bladder.  I  learnt  that  they 
had  always  used  the  smallest  instruments  ;  by,  on  the  contrary,  using 
the  largest  I  could  find,  I  reached  the  bladder  without  difficulty. 


CASE  III. 

Blennorrhagia — Retention  of  Urine,  &c. — Apoplexy — Death. 

AVTOTSY. -^Efusion  of  Blood  into  the  left  ventricle  of  the  brain — Hyper- 
trophy of  the  heart — Gatro- enteritis — Abscess  and  tubercles  in  the  kidneys 
and  prostate — Stricture,  ^t'c. 

Gojon,  at  the  age  of  forty,  contracted  an  acute  blennorrhagia,  with 
orchitis.  Treated  by  irritating  medicines,  which  produced  diarrhoea  and 
violent  colic,  it  diminished,  but  did  not  entirely  disappear,  a  slight  urethral 
discharge  continuing  for  ten  years,  with  pain  in  the  prostatic  region  and  fossa 
navicularis.  He  was  also  annoyed  by  obstinate  constipation.  Between  the 
ages  of  fifty  and  sixty  he  experienced  difficulty  in  discharging  his  urine,  a 
feeling  of  uneasiness  in  the  urinary  apparatus,  weakness  of  the  body,  diffi- 
culty of  digestion,  considerable  loss  of  flesh,  and  a  remarkable  diminution  in 
his  intellectual  powers.  Still  later  he  had  frequent  attacks  of  retention  of 
urine,  successfully  treated  by  baths  and  demulcents,  intolerable  pain  in  the 
kidneys  and  bladder,  hypochondriasis,  a  strong  aversion  to  frequent  places, 
melancholy,  and  serious  debility. 

On  the  first  of  February,  1827,  retention  of  urine  occurred,  for  which 
leeches  were  applied  to  the  perineum,  and  general  baths  and  demulcents 
were  employed  without  relief;  active  inflammation  of  the  perineum  and 
cellular  tissue  of  the  scrotum  took  place,  for  which  fomentations  were  ap- 
plied. 

On  the  5th  the  skin  of  the  perineum  gave  way  in  three  places,  and  a  large 
quantity  of  urine  mixed  with  pus  was  discharged. 

On  the  10th  of  February  this  patient  was  brought  to  the  hospital.  He 
was  sixty-five  years  of  age,  his  skin  was  warm,  and  his  pulse  full  and  sti'ong  ; 
cheeks  red,  eyes  watery,  with  pain  under  the  orbits ;  ideas  pretty  clear, 
tongue  red  and  dry,  severe  thirst  and  a  desire  for  cold  drinks ;  abdomen  sen- 
sitive on  pressure,  especially  in  the  hypogastric  region  ;  attempts  at  catheterism 
unsuccessful.     Fomentations  were  ordered  to  the  abdomen. 

On  the  11th  an  attack  of  apoplexy  occurred,  and  on  the  12th  he  died. 


POST-MORTEM  APPEARANCES. 

Head. — Considerable  effusion  of  florid  blood  in  the  left  lateral  ventricle. 
Chest. — Lungs  crepitant.     Hypertrophy  of  the  left  ventricle  of  the  heart. 
Abdomen. — Mucous  membrane  of  the  stomach  red  throughout   its   whole 


SPERMATIC    ORGANS.  47 

extent;  covered  by  little  spots  of  ulceration  scattered  here  and  there;  the 
injectioa  of  the  intestines  becoming  more  and  more  remarkable  in  the 
neighborhood  of  the  anus.     Some  ulceration  in  the  rectum. 

Genito -urinary  organs. — From  ten  to  twelve  abscesses  were  found  in  each 
kidney;  and  in  the  left,  ci'ude  tubercles,  about  the  size  of  a  bean,  existed. 
The  ureters  were  dilated,  and  their  lining  membrane  red  and  injected. 
Bladder  hardened  and  columnar,  an  inch  in  thickness.  Mucous  membrane 
of  a  violet  color,  thick,  soft,  and  ulcerated  in  several  points.  Prostate 
three  times  its  normal  size ;  more  developed  under  the  neck  of  the  bladder 
than  towards  the  rectum ;  furnishing,  by  pressure,  a  very  abundant  purulent 
discbarge,  and  containing  about  thirty  little  abscesses  and  as  many  crude 
tubercles.  This  prostate  resembled  the  tissue  of  a  lung  full  of  tubercles, 
of  which  some  are  empty,  others  suppurating,  and  others  immature.  The 
seminal  vesicles  and  vasa  deferentia  thickened. 

There  was  a  circular  stricture  in  the  urethra,  about  half  an  inch  in  front 
of  the  prostate,  formed  by  a  tissue  of  a  horny  consistence,  and  scarcely 
permitting  the  introduction  of  a  No.  2  catheter.  An  enormous  dilatation 
of  the  urethra  was  observed  between  the  stricture  and  the  neck  of  the 
bladder,  and  the  mucous  membrane  of  this  portion  of  the  canal  was  thick- 
ened, fungous,  and  softened,  and  presented  in  its  posterior  part  a  fissure 
whence  three  fistulas  took  their  origin. 

The  cellular  tissue  of  the  perineum  and  scrotum  was  full  of  pus.  The 
testicles  were  healthy. 

This  patient  died  the  day  after  his  entry  into  the  hospital,  and 
during  this  short  space  his  state  had  not  permitted  us  to  think  of  in- 
voluntary spermatic  discharges,  always  very  difficult  to  detect  in  cases 
of  this  nature.  This  stricture  was,  however,  seated  a  little  in  front  of 
the  orifices  of  the  ejaculatory  ducts,  and  the  prostatic  raucous  mem- 
brane was  disorganized  by  inflammation ;  nothing  is  more  common 
than  spermatorrhoea  under  these  circumstances.  On  the  other  hand 
the  prostate  was  considerably  altered,  and  the  seminal  vesicles  and 
vasa  deferentia  were  much  thickened.  It  is  then  to  be  presumed  that 
the  loss  of  intellect,  the  great  debility  of  the  system,  &c.,  arose,  as 
in  the  preceding  cases,  from  habitual  spermatic  discharges. 

Death  was  caused  by  a  large  effusion  of  blood  in  the  left  lateral 
ventricle.  Was  the  hemorrhage  the  result  of  one  of  those  cerebral 
congestions  of  which  we  have  spoken  in  the  preceding  cases  ?  Ana- 
logy seems  to  indicate  that  it  was. 

Hypertrophy  of  the  left  ventricle  of  the  heart  was  present,  how- 
ever, and  the  influence  which  the  increased  development  of  this 
organ  exercises  on  the  brain  is  well  known.  If  this  hypertrophy 
were  not  the  sole  cause  of  the  effusion,  it  had,  without  doubt,  a  large 
share  in  producing  it.  In  obscure  questions  like  that  which  occupies 
us  we  must  only  admit  facts  that  are  incontrovertible,  and  we  must 
resist  as  much  as  possible  the  attraction  of  pre-conceptions.  I  have, 
therefore,  reported  this  case,  because  it  confirms  what  I  have  stated 
respecting  the  facility  with  which  inflammation  of  the  mucous  mem- 
brane of  the  urethra  extends  to  all  the  other  mucous  membranes 
connected  with  it. 


48  INFLAMMATION    OF    THE 

The  first  disease  was  urethritis  with  orchitis.  Thus,  at  the  he- 
ginning  the  inflammation  extended  from  the  urethra  to  the  testicles 
by  then-  excretory  ducts,  and  the  manner  of  this  extension  cannot 
be  doubted,  because  twenty-five  years  afterwards  the  vasa  deferentia 
and  vesiculge  serainales  were  still  thickened.  The  extension  of  the 
inflammation  in  the  direction  of  the  urinary  passages  was  still  more 
evident  for  not  only  the  prostatic  mucous  membrane  was  thickened, 
fungous,  and  softened,  but  that  of  the  bladder  was  thick  and  softened, 
also,  violet  colored  and  even  ulcerated  in  several  points;  the  ureters 
were  dilated,  and  their  inner  surfaces  red  and  injected  ;  lastly,  each 
kidney  contained  ten  or  twelve  abscesses,  tubercles  also  existing  in 
the  left. 

The  prostate  is  the  principal  seat  of  blennorrhagic  discharges  ; 
being  situated  at  the  junction  of  the  urinary  with  the  genital  appa- 
ratus, it  cannot  fail  to  be  affected  by  disorders  which  extend  to  tissues 
very  far  from  their  points  of  origin  ;  thus  it  was  still  more  diseased 
than  the  kidneys.  It  was  three  times  its  normal  size,  and  independ- 
ent of  the  purulent  matter  furnished  by  its  mucous  follicles  it  con- 
tained about  thirty  small  abscesses  and  as  many  crude  tubercles. 

I  shall  remark,  as  I  proceed,  that  the  circumstances  under  which 
the  tubercles  of  the  prostate  and  left  kidney  were  developed,  and  the 
existence  of  these  tubercles  by  the  side  of  recent  abscesses,  leave 
no  doubt  as  to  the  cause  of  their  formation. 

Before  concluding  these  reflections,  I  must  also  notice  that  traces 
of  acute  gastro-enteritis  and  even  of  ulceration  of  the  rectum  were 
present.  It  is  to  this  complication  that  we  must  attribute  the  red- 
ness and  dryness  of  the  tongue,  the  extreme  thirst,  and  the  sensi- 
tiveness of  the  abdomen  to  pressure — characteristic  symptoms  of 
inflammation  of  the  digestive  organs,  which  we  must  not  confound 
with  derangement  of  their  functions,  or  with  the  gastralgia  that  so 
frequently  accompanies  spermatorrhoea  ;  neither  must  we  confound 
the  hemorrhage  that  caused  death  with  the  cerebral  congestions  of 
which  I  have  spoken  in  the  two  preceding  cases. 

Unfortunately,  these  distinctions  are  very  difficult  to  be  established 
in  some  cases,  as  alterations  of  tissue  often  follow  purely  sympathetic 
functional  derangements  so  suddenly,  that  it  is  impossible  to  specify 
the  moment  when  the  afi"ection  becomes  really  idiopathic.  This  is, 
above  all  others,  the  circumstance  which  has  hitherto  thrown  so  thick 
a  veil  over  cases  of  spermatorrhoea;  and  which  renders  the  minute 
examination  of  each  case  so  necessary. 


SPERMATIC    ORGANS.  49 


CASE  IV. 

Mental  derancjement — Belief  in  a  change  of  sex — Death. 
Autopsy. —  Thickening  of  the  arachnoid — Great  alteration  of  the  prostate 
— Atrophy  and  ohliteration  of  the  ejaculatory  ducts. 

I  find  the  following  particulars  related  by  Professor  Rech  respecting  an 
insane  person  who  died  under  his  care.  "  The  intellect  had  been  disordered 
for  a  long  time ;  the  patient  believed  he  had  changed  his  sex,  and,  thinking 
himself  a  woman,  spent  much  of  his  time  in  writing  to  an  imaginary  lover; 
sometimes  he  fell  on  his  knees  and  seemed  to  dig  the  ground  for  hours  to- 
gether. He  had  entirely  lost  the  power  of  vision  in  the  left  eye.  His  death 
took  place  from  exhaustion  after  an  obstinate  diarrhoea.  At  the  post-mor- 
tem inspection,  the  dura  mater  was  found  healthy  throughout;  the  arach- 
noid was  thickened  in  several  points,  and  opacities  were  found  on  its  sur- 
face which  obscured  its  transparency.  The  pia  mater  contained  a  consi- 
derable quantity  of  serosity,  especially  between  the  cerebral  convolutions. 
The  brain,  cerebellum,  and  medulla  oblongata  were  healthy  in  all  their 
parts.  The  optic  nerve  of  the  right  side  was  atrophied  behind  the  commis- 
sure to  the  extent  of  half  an  inch,  of  a  grayish  color  and  very  soft.  In  the 
left  eye,  the  retina  was  separated  from  the  choroid  by  a  considerable  serous 
effusion ;  the  vitreous  humor,  apparently  atrophied,  formed  a  reddish  and 
irregular  mass.  The  lungs  and  heart  were  healthy,  but  the  latter  was  re- 
markable for  its  small  size. 

"The  mucous  membrane  of  the  intestines,  from  the  coecum  downwards, 
was  red  and  thickened;  and  this  alteration  increased  in  intensity  near  the 
rectum,  in  which  numerous  ulcerations  existed. 

"The  prostate  projected  into  the  bladder,  and  was  nearly  two  inches  in 
extent  in  its  long,  and  fifteen  lines  in  its  transverse  diameter;  its  structure 
contained  three  small  abscesses.  The  ejaculatory  ducts  were  softened,  atro- 
phied, and  obliterated.  The  vasa  deferentia  and  the  vesiculae  seminales 
were  on  the  contrary  larger  than  ordinary." 

The  patient  died  of  a  chronic  diarrhoea,  and  the  intestinal  mucous 
membrane  was  injected,  thickened,  and  ulcerated  ;  he  had  lost  his 
power  of  vision  in  the  left  eye,  and  this  eve  was  extensively  altered, 
as  was  also  the  right  optic  nerve,  before  its  entering  the  optic  com- 
missure ;  he  believed  himself  to  be  a  girl,  and  the  functions  of  the 
testes  must  have  been  abolished,  since  the  ejaculatory  ducts  were 
atrophied  and  obliterated.  If  this  singular  alteration  of  the  genital 
organs  were  not  the  cause  of  the  patient's  derangement,  it  must  at 
least  have  influenced  its  peculiar  character. 


SUMMARY    OF    THE    PRECEDING    OBSERVATIONS. 

Symptoms. — In  the  first  two  patients  only,  were  involuntary  sper- 
matic discharges  discovered,  and  their  general  symptoms  well  de- 
scribed.    The  other  cases  are  hardly  of  importance,  except  in  respect 


50  INFLAMMATION    OF    THE 

of  their  pathological  illustrations.  It  is  only  in  the  first  two  cases 
that  the  progressive  deterioration  of  the  spermatic  organs  can  be 
■well  followed,  from  the  first  blennorrhagia  to  th^  patient's  death ; 
and  that  the  ever  increasing  influence  of  spermatorrhoea  over  the 
whole  economy,  but  especially  over  the  cerebro-spinal  system,  can 
be  appreciated. 

The  delusions  produced  in  both  patients  by  the  last  class  of  symp- 
toms are  well  fitted  to  open  the  eyes  of  practitioners  as  regards  cases 
of  this  nature.  The  consequences  resulting  from  them  in  a  thera- 
peutic point  of  view  are  so  serious,  that  we  cannot  well  attach  too 
much  importance  to  their  due  consideration. 

But  how  can  extreme  cases  of  spermatorrhoea  so  closely  simulate 
affections  of  the  brain,  or  of  its  membranes  ?  and  by  what  charac- 
ters can  we  distinguish  their  symptoms  from  those  arising  from  idio- 
pathic aiFections  of  the  same  organs?  In  order  properly  to  discuss 
questions  of  this  kind,  it  is  indispensable  to  have  before  us  all  the 
facts  influencing  them  ;  but  in  passing,  we  may  hastily  consider 
those  with  which  we  are  already  acquainted. 

In  the  first  two  cases,  the  cerebral  symptoms  were  preceded,  during 
a  long  period,  by  a  remarkable  derangement  of  the  other  functions  : 
thus,  digestion  was  performed  badly ;  the  stomach  no  longer  bore 
fermented  drinks,  spiced  meats,  or  very  nutritious  food ;  stubborn 
constipation  supervened  ;  the  intestinal  tube  was  habitually  distended 
by  flatus ;  sexual  intercourse  became  more  and  more  rare,  the  act 
more  rapid,  and  at  last  entirely  impossible.  The  patients,  in  these 
cases,  discontented  with  themselves  and  their  friends,  and  tormented 
by  flatus,  of  which  they  want  continually  to  relieve  themselves,  shun 
society  and  its  trammels ;  they  dislike  everything  which  recalls  to 
them  pleasures  they  are  unable  to  share;  they  become  melancholic 
and  irritable,  misanthropic  and  hypochondriacal ;  ever  occupied  by 
the  consideration  of  their  health,  they  manifest  the  utmost  indiffer- 
ence for  all  things  which  do  not  affect  it. 

The  cerebral  functions  are  not  more  weakened  than  all  the  rest, 
but  their  disorder  produces  more  serious  consequences,  and  is  more 
readily  perceived.  It  is  soon  remarked,  that  memory  becomes  im- 
paired, that  the  train  of  thought  is  easily  interrupted,  and  that  the 
least  excitement  of  the  intellect  induces  congestion  towards  the 
head.  Difficult  digestion,  more  obstinate  constipation,  and  abdomi- 
nal distension  by  flatus,  supervene  in  these  cases,  which  end  by  at- 
tacks of  congestion  in  the  fatigued  and  weakened  brain. 

But  these  congestions  are  accompanied  with  a  remarkable  feebleness 
of  the  pulse,  chilliness  of  the  limbs,  general  uneasiness,  anxiety, 
agitation  in  every  sense,  and  a  remarkable  desire  for  motion.  They 
are  immediately  followed  by  pallidity  of  the  countenance,  general 
debility,  and  alarming  faintness,  witJiout  any  one  ijart  of  the  body 
being  more  affected  than  the  rest. 

Apoplectic  congestions  are  never  preceded  for  years  by  a  progres- 
sively increasing  weakness  of  the  economy;  the  pulse  is  lull,  and 
there  is  a  tendency  to  drowsiness. 


SPERMATIC    ORGANS.  51 

The  patient  whose  case  I  have  related  in  my  third  observation, 
died  in  consequence  of  an  extensive  cerebral  hemorrhage,  which 
came  on  suddenly  in  the  left  lateral  ventricle  of  the  brain ;  but  this 
patient  had  hypertrophy  of  the  heart,  and  the  first  attack  promptly 
caused  death ;  it  is,  therefore,  probable  that  the  congestion  was  not 
due  to  the  same  cause,  and  it  certainly  did  not  present  the  same 
characters  as  in  the  two  preceding  cases. 

The  disorder  observed  in  the  ideas  of  such  patients  cannot  be 
confounded  with  delirium ;  whenever  delirium  has  been  really  pre- 
sent in  these  cases,  true  meningitis  has  been  found  to  exist,  of 
which  I  have  seen  numerous  examples.  The  state  of  the  intellect, 
in  these  aifections,  manifests,  perhaps,  a  greater  resemblance  to 
deraency ;  but  demency  commonly  follows  mental  derangement ; 
besides,  it  is  always  easy  to  obtain,  in  the  cases  I  am  considering, 
clear  and  connected  answers. 

It  is  impossible  also  to  confound  the  disorder  of  the  digestive  func- 
tions with  the  symptoms  of  inflammation  of  these  organs  ;  in  all  cases 
in  which  inflammatory  symptoms  are  observed,  gastro-enteritis  is 
actually  present. 

Lesions. — It  is  chiefly  on  accouut  of  the  alterations  discovered 
in  the  spermatic  organs  that  the  cases  I  have  hitherto  recorded  are 
of  value.  The  influence  of  the  urethra  on  all  the  organs  which 
open  into  it,  is  an  important  phenomenon  in  the  history  of  sperma- 
torrhoea. To  have  a  clear  idea  of  this  influence,  it  is  necessary 
especially  to  prove  the  facility  with  which  inflammation  creeps  along 
the  mucous  membranes,  to  even  their  most  distant  continuations. 

Prostate. — Blennorrhagic  discharge  arises  from  the  mucous  folli- 
cles of  the  urethra,  and  of  the  prostate  especially,  where  they  are 
most  developed  and  most  numerous :  the  prostate,  in  fact,  is  formed 
of  these  follicles,  united  by  cellular  tissue. 

During  the  first  days  after  contagion,  a  tickling  in  the  urethra 
is  felt,  with  itching  heat  and  pain,  especially  during  the  emission 
of  urine.  The  secretion  of  the  canal  is  increased,  and  changes  its 
appearance,  but  it  is  not  until  the  inflammation  has  reached  the 
prostate,  that  the  discharge  acquires  its  greatest  severity.  It  is 
then  principally  secreted  by  the  prostate,  and  experienced  patients 
seem  to  be  aware  of  this,  for  in  doubtful  cases  we  see  them  com- 
press the  urethra  from  the  perineum  to  the  glans  penis,  in  order  to 
expel  the  secretion.  Besides,  post-mortem  examinations  permit  no 
doubt  to  remain  on  the  subject. 

But  the  irritating  m.atter  which  excites  the  disease  is  not  deposited 
on  the  surface  of  the  prostate,  and  it  is  not  because  this  matter  con- 
tains a  contagious  principle,  that  the  inflammation  is  propagated  so 
rapidly  from  the  orifice  of  the  urethra  to  the  prostatic  mucous  folli- 
cles, for  leucorrhoea,  the  menstrual  discharge,  or  the  lochia,  are  fre- 
quently sufficient  to  excite  a  profuse  discharge,  the  seat  of  which  is 
equally  in  the  mucous  follicles  of  the  prostate. 


52  INFLAMMATION    OF    THE 

It  is  not  the  passage  of  the  irritating  matter  from  one  point  of 
tlie  mucous  surface  to  another,  that  favors  this  propagation,  for 
the  discharge  passes  from  behind  forwards,  and  the  inflammation 
extends  in  the  opposite  direction. 

However  it  may  arise,  the  fact  is  constant,  and  it  clearly  explains 
the  frequency  of  prostatic  disease  as  a  sequel  to  blennorrhagia. 

In  the  beginning  of  a  very  acute  inflammation,  the  prostatic  folli- 
cles are  gorged  with  a  thick  adhesive  pus,  and  form  a  firm  and  yel- 
lowish body  like  a  scrofulous  tubercle  ;  the  cellular  tissue  surround- 
incr  them  is  so  far,  however,  perfectly  healthy,  so  that  the  follicles 
can  be  easily  separated  from  one  another  throughout  their  extent, 
and  the  nature  and  seat  of  their  changes  can  thus  be  proved. 

At  a  more  advanced  period  of  the  disease,  we  find  the  prostate  in- 
filtrated with  pus  or  a  pultaceous  matter,  which  may  be  pressed  out 
in  the  form  of  granules;  the  cellular  tissue  is  now,  therefore,  attacked 
by  the  inflammation,  but  suppuration  is  not  yet  well  established. 

At  a  still  more  advanced  period,  by  slightly  compressing  the  pros- 
tate, pus  may  be  made  to  exude  from  all  its  excretory  ducts,  and  it 
contains,  besides,  little  abscesses  from  the  size  of  a  linseed  to  that  of 
a  pea.  Here  the  suppuration  of  the  cellular  tissue  has  begun  to 
form  into  distinct  collections. 

In  the  third  case  I  have  related,  the  prostate  was  three  times  its 
normal  size,  and  furnished,  on  pressure,  a  very  abundant  purulent 
matter;  it  contained  besides  this  about  thirty  little  abscesses,  and  as 
many  crude  miliary  tubercles.  We  observe  here  the  same  progress 
of  the  inflammation,  but  the  abscesses,  in  place  of  discharging  their 
contents,  were  transformed  into  tubercles  by  the  absorption  of  the 
fluid  parts  of  the  pus. 

In  the  first  case  I  have  reported  the  prostate  was  partly  destroyed, 
and  contained  in  its  fibrous  envelope  an  elastic  and  purulent  matter, 
which  passed  into  the  canal  of  the  urethra,  through  a  number  of 
foramina  in  the  mucous  membrane.  These  foramina  were  the  orifices  . 
of  the  mucous  follicles  whose  parietes  had  been  destroyed  by  sup- 
puration. 

We  see  by  these  observations,  then,  that  the  inflammation  extends 
from  the  urethral  mucous  membrane  to  that  lining  the  mucous  folli- 
cles of  the  prostate,  and  afterwards  to  the  cellular  tissue  uniting 
them  ;  that  abscesses  form,  and  either  discharge  their  contents  by 
the  mouths  of  these  follicles  after  having  destroyed  their  parietes, 
or  in  other  cases  form  tubercles,  which  end  in  the  same  way  ;  that 
the  prostate  becomes  destroyed  by  degrees,  and  is  reduced  to  a 
fibrous  envelope,  quite  perfect,  and  covered  by  a  kind  of  perforated 
membrane,  the  foramina  in  which  vary  in  form  and  size,  according 
as  the  excretory  orifices  remain  distinct,  or  are  united  together  by 
the  destruction  of  the  intervening  tissue  which  separates  them. 

When  the  inflammation  of  the  prostatic  cellular  tissue  is  less  severe, 
in  place  of  pus,  an  albuminous  matter  is  deposited,  which  infiltrates 


SPERMATIC    ORGANS.  53 

the  part  and  gives  vise  to  indolent  engorgement,  and  if  this  he  not 
dispersed  promptly  and  entirely,  induration  of  the  prostate  will  re- 
sult.    I  have  seen  many  cases  in  which  this  has  occurred. 

Spermatic  Organs. — The  frequency  of  orchitis  arising  from  blen- 
norrhagia  shows  with  what  facility  inflammation  of  the  urethi-a  extends 
to  the  testicles.  This  extension  takes  place  by  means  of  the  mucous 
membrane.  Injury,  exposure  to  cold,  &c.,  may  indeed  favor  the 
development  of  orchitis  ;  but  its  principal  cause,  often  its  sole  cause, 
is  the  influence  of  the  urethral  mucous  membrane  over  that  lining 
the  excreting  organs  of  the  semen. 

Both  patients  and  practitioners  are  in  many  cases  much  puzzled 
to  understand  the  appearance  of  orchitis,  and  they  would  be  still 
more  so  if  preconceived  opinions  did  not  facilitate  its  explanation. 
Sometimes  it  is  from  having  walked  too  far,  or  from  having  sat  too 
long,  sometimes  from  having  worn  too  tight  a  pair  of  trousers,  or 
from  having  bruised  the  testicles  by  crossing  the  legs,  that  the  dis- 
ease has  arisen.  But  who  is  not  exposed  to  the  action  of  such  causes  ? 
I  admit  that  it  is  often  immediately  after  a  circumstance  of  this  kind 
that  the  patient  experiences,  for  the  first  time,  a  more  or  less  sharp 
pain  in  the  testicle,  which  is  soon  afterwards  followed  by  the  other 
symptoms  of  orchitis  ;  but  those  patients  who  observe  carefully  never 
fail  to  remark,  that  they  first  experience  a  sense  of  weight  in  the 
inguinal  region,  and  of  dragging  and  pain  in  the  spermatic  cord. 
On  examining  the  cord  of  the  affected  side,  the  vas  deferens  is  then 
found  to  be  swollen  and  very  sensitive,  and  it  even  sometimes  hap- 
pens that  the  swelling  of  the  cord  is  so  great  as  to  cause  a  kind  of 
strangulation  in  the  inguinal  canal. 

When,  afterwards,  the  inflammation  extends  to  the  body  of  the 
testicle,  it  is  attributed  to  the  first  cause  which  drew  attention  to  the 
morbid  sensibility  of  the  organ,  and  then  it  is  that  the  urethral  dis- 
charge diminishes  or  becomes  suppressed,  according  as  the  new  in- 
flammation is  more  or  less  severe.  The  suppression  of  tlie  discharge 
makes  the  patient  imagine  that  the  afl"ection  itself  has  attacked  the 
testicle,  and  many  medical  men  even  believe  that  the  suppression 
does  give  rise  to  orchitis.  They  are  deceived  by  taking  the  effect 
for  the  cause  ;  but  it  is  not  the  less  true  on  this  account,  that  the 
inflammation  of  the  canal  has  originated  that  of  the  testicle ;  indeed 
the  succession  of  the  symptoms  ought  to  be  sufficient  to  show  the 
course  the  disease  has  taken. 

When  both  testicles  have  been  affected,  both  ejaculatory  ducts 
are  found  altered,  and  when  both  seminal  vesicles  or  both  vasa  defe- 
rentia  have  been  inflamed,  the  same  alteration  is  remarked  in  both  the 
ejaculatory  ducts.  When  one  only  of  the  spermatic  organs  has  been 
inflamed,  I  have  always  been  able  to  trace  the  inflammation  to  the 
orifice  of  the  corresponding  ejaculatory  duct,  whilst  the  other  has  been 
found  unaffected.  I  have  also  seen  the  inflammation  spread  without 
interruption  as  far  as  the  tunica  vaginalis  of  the  testicle  or  of  both  tes- 
ticles, according  as  the  disease  has  extended  on  one  side  or  on  both. 
4 


54  INFLAMMATION   OF    THE 

This  affection  of  the  tunica  vaginalis  may  be  easily  explained  since 
any  alteration  of  the  glandular  tissue  is  readily  partaken  by  its 
fibrous  covering,  which  is  intimately  united  with  the  serous  tissue 

coating  the  gland.  i    .      ir-    ^i 

Inflammation  of  the  seminal  vesicles  extends  itself  m  the  same  man- 
ner in  some  cases,  to  the  adjacent  peritoneum.  In  the  first  case  I 
have  related  this  inflammation  was  quite  recent ;  the  matter  depo- 
sited on  the  surface  of  the  serous  membrane  was  still  albuminous, 
soft,  and  unorganized  ;  and  in  the  second  case,  the  bladder  was  united 
to  the  rectum  by  cellular  adhesions,  evidently  due  to  the  same  cause. 
These  observations  are  of  greater  importance  than  they  appear  ; 
they  prove  that  general  peritonitis  might  easily  arise  from  the  dis- 
eases we  have  been  studying.  The  old  and  circumscribed  adhesions 
of  peritonitis  which  sometimes  line  the  bottom  of  the  pelvis,  ought 
also  to  be  noted  as  being  almost  certain  proof  of  old  inflammation 
of  the  seminal  vesicles;  they  may,  therefore,  assist  much  in  explain- 
ing the  symptoms  observed  during  life,  when  the  alterations  of  the 
spermatic  organs  have  passed  away,  or  do  not  leave  any  very  ap- 
parent traces.  However  this  may  be,  these  alterations  of  the  pe- 
ritoneum and  of  the  tunica  vaginalis  prove  that  the  inflammation  is 
propagated  by  contiguity  of  tissue. 

But  it  is  necessary  to  examine  a  little  more  in  detail  the  state  of 
the  diiferent  spermatic  organs. 

Orifices  of  the  Ejaculatory  Ducts. — In  the  patient  who  was  the 
subject  of  the  first  case,  the  orifices  of  the  ejaculatory  ducts,  in  place 
of  being  circular,  formed  one  elongated  and  irregular  cleft.  The 
ducts  themselves  were  very  large.  This  enlargement  has  been  no- 
ticed by  StolP  in  a  case  related  by  him ;  and  it  was  still  more  re- 
markable in  a  body  I  once  saw  in  the  School  of  Medicine,  in  which 
the  opening  admitted  a  goose-quill.  In  all  these  cases  still  more  seri- 
ous lesions  existed,  but  it  is  easy  to  conceive  that  the  dilatation  or 
ulceration  of  the  sphincters  which  terminate  the  ejaculatory  ducts, 
may  alone  possess  great  influence  over  the  production  of  spermator- 
rhoea, and  I  should  not  be  surprised  if  we  should  find  sometimes  no 
other  lesion  capable  of  accounting  for  it. 

The  Ejaculatory  Ducts  generally  share  the  alteration  and  dilatation 
of  their  orifices ;  besides  which,  they  may  be  insulated,  as  though  dis- 
sected, by  the  suppuration  of  the  prostate,  or  thickened,  hardened, 
and  cartilaginous,  or  they  may  even  contain  osseous  granules.  These 
alterations,  much  more  serious  than  those  of  their  orifices,  must  dis- 
pose very  much  to  the  involuntary  escape  of  the  semen.  The  ducts 
having  lost  their  elasticity,  and  even  their  power  of  contraction,  are 
no  longer  able  to  drive  back  the  semen  into  the  seminal  vesicles ;  or 
at  least  they  are  incapable  of  retaining  it,  however  gently  these  re- 
servoirs may  contract,  or  however  little  they  may  be  compressed. 


'  Pars  prima  rationis  medendi. 


SPERMATIC    ORGANS.  55 

The  pressure  exerted  on  these  ducts,  by  the  swelled  tissue  of  the 
prostate,  may  cause  their  atrophy  or  obliteration,  whence,  of  course, 
ensues  the  more  or  less  complete  loss  of  their  functions. 

Seminal  Vesicles. — It  would  appear  that  pus  formed  in  the  seminal 
vesicles  should  be  easily  expelled ;  but  these  two  receptacles,  com- 
posed of  ramified  cells,  are  placed  out  of  the  direct  course  of  the  se- 
men, to  be  used  as  reservoirs  for  it ;  and  they  only  communicate 
with  the  vasa  deferentia  and  the  ejaculatory  ducts,  by  a  very  narrow 
opening,  in  front  of  which  the  seminal  fluid  may  pass  to  be  discharged 
directly  from  the  testicles  to  the  urethra;  it  seems  that  the  swelling 
produced  by  inflammation  may  so  much  lessen  this  opening  as  to  form 
an  obstacle  to  the  exit  of  pus,  for  a  shorter  or  longer  period :  in  one 
case  which  I  had  an  opportunity  of  examining,  the  pus  had  acquired 
a  considerable  thickness,  and  that  at  the  bottom  of  the  cells  was  still 
more  thickened,  exactly  resembling  tuberculous  matter.  The  resi- 
dence of  the  pus  in  this  situation  may  be  even  still  more  prolonged, 
should  the  watery  part  be  more  completely  absorbed  ;  in  these  cases 
we  find  only  a  yellowish  homogeneous  substance,  soft,  like  plaster, 
or  even  chalky,  the  true  origin  of  which  has  been  entirely  mistaken. 

It  is  almost  unnecessary  to  notice  that  the  presence  of  pus  prevents 
the  entrance  of  the  semen  into  the  reservoirs  intended  for  it,  and 
that  it  becomes,  from  this  alone,  an  immediate  cause  of  spermator- 
rhoea. We  can  easily  understand,  also,  that  after  the  expulsion  of 
the  pus,  the  parietes  of  the  vesicles  must  be  thickened,  and  that 
they  may  always  remain  hardened,  altered  in  shape,  thickened,  car- 
tilaginous, or  even  bony.  In  more  favorable  cases,  also,  their 
lining  membrane  must  preserve,  during  a  long  time,  an  abnormal 
sensibility,  the  influence  of  which  must  be  very  injurious. 

It  is  not,  however,  necessary  that  such  serious  alterations  should 
exist  in  the  seminal  vesicles  in  order  to  account  for  the  irregular  and 
spasmodic  contractions  of  which  they  are  sometimes  the  seat ;  or  for 
their  influence  on  the  production  of  spermatorrhoea  ;  but  it  is  useful 
to  understand  fully  the  most  striking  changes  in  order  the  better  to 
appreciate  the  slighter  ones. 

The  qualities  of  the  semen  found  in  the  seminal  vesicles  should 
also  be  carefully  noticed  :  I  have  seen  it  resemble  meconium  in  one 
of  these  receptacles  whilst  pus  existed  in  the  other  ;  and  it  is  probable 
that  the  alteration  of  the  secretion  of  the  one  testicle  was  due  to  a 
similar  influence  which,  in  the  same  case,  had  acted  still  more 
evidently  on  the  opposite  organ. 

Vasa  Deferentia. — Pus  formed  in  the  vasa  deferentia  is  not  in 
all  cases  easily  expelled ;  swelling  of  their  walls  may  bring  about 
complete  obliteration  of  these  vessels  in  one  or  more  points,  whilst 
in  others  they  are  distended  by  the  accumulation  of  the  pus,  so  that 
pouches,  more  or  less  dilated  and  separated  by  contractions,  somewhat 
resembling  irregular  chaplets,  are  formed.  This  disposition  may 
extend  itself  to  the  epididymis,  and  to  the  corpora  Highmoriana, 


5g  INFLAMMATION    OF    THE 

the  mucous  membranes  of  Avhicli  are  continuous  with  those  of  the 
vasa  deferentia  at  one  part,  and  with  those  of  the  secretory  tubes  at 

^^Pus^^thus  separated  and  submitted  for  an  indefinite  time  to  the  ac- 
tion of  the  absorbents,  becomes  more  and  more  solid,  and  gives  rise 
to  deposits  resembling  those  of  tuberculous  matter,  the  aspect  and 
consistence  of  which  may  present  every  degree  of  alteration  in  the 
same  individual,  according  to  the  age  and  size  of  the  abscess. 

From  this  obliteration  of  the  vasa  deferentia,  retention  ot  the 
semen  in  the  testicles  also  results,  so  that  the  generative  power  is  lost ; 
but  it  does  not  necessarily  follow  from  this  that  the  patient  should 
be  free  from  spermatic  discharges.  If  the  abscesses  of  the  epididy- 
mis open  externally,  we  can  understand  that  the  semen  will  escape 
immediately  through  this  rupture  of  the  excretory  canal,  and  that  m 
this  way  a  true  spermatic  fistula  is  formed  ;  and  should  this  take 
place  on  both  sides,  it  is  clear  that  the  patients  Avould  be  exposed  to 
the  same  phenomena  as  if  they  were  affected  by  spermatorrhoea. 

If  the  obliteration  of  the  excretory  canal  be  not  followed  by  rup- 
ture, it  is  probable  that  the  secreting  organ,  after  having  been  a  long 
time  distended,  swollen,  and  painful,  will  in  the  end  diminish  by  de- 
grees, and  will  become  completely  atrophied,  as  happens  to  other 
glands  under  the  same  circumstances.  Thus,  certain  cases  of  atrophy 
of  the  testicles,  after  a  very  long  and  painful  swelling  of  them,  may 
be  accounted  for. 

When  the  vasa  deferentia  are  felt  hard  and  knotty  there  can  be 
no  doubt  as  to  the  cause  of  this  atrophy  ;  but  sometimes  the  altera- 
tion takes  place  in  parts  where  manual  examination  is  impossible, 
and  in  these  cases  the  state  of  the  prostate  will  be  likely  to  furnish 
important  information :  when  it  is  found  irregular,  swollen,  and 
enlarged,  the  atrophy  of  the  testicles  must  be  regarded  as  the  conse- 
quence of  pressure  on  the  ejaculatory  ducts. 

In  an  officer  whose  case  I  treated,  the  testicles  were  not  larger 
than  those  of  a  child  of  six  years ;  the  patient  had  experienced  a 
continued  dull  pain  in  them  for  a  long  time ;  the  prostate  was  much 
altered  ;  his  moral  faculties  had  experienced  the  same  changes  that 
occur  in  cases  of  spermatorrhoea,  but  the  physical  man  was  not  much 
weakened ;  the  reason  of  this  is  evident. 

Chronic  atrophy  of  the  testicles,  following  more  or  less  acute  pain 
in  them,  is  by  no  means  rare :  these  pains  are  usually  considered 
nervous,  and  the  insensible  wasting  which  follows  them  has  not  been 
as  yet  satisfactorily  explained.  All  the  patients  of  this  kind  whom 
I  have  had  an  opportunity  of  observing,  had  suffered  previously  from 
bldhnorrhagia,  of  which  I  am  convinced  this  atrophy  was  the  distant 
but  direct  result. 

We  often  find  the  vasa  deferentia  thickened,  hardened,  cartilagi- 
nous, or  even  quite  ossified,  in  patients  who  have  had  orchitis.  These 
cases  confirm  what  I  have  stated  respecting  the  mode  of  transmission 


SPERMATIC    ORGANS.  '  57 

of  inflammation  from  the  urethra  to  the  testicles,  for  all  these  shades 
of  induration  are  so  many  results  of  inflammatory  action. 

Testicles. — Every  surgeon  knows  how  slowly  enlargement  of  the 
epididymis  and  corpus  Highmorianum,  following  orchitis,  is  dis- 
persed. This  fact  alone  is  sufiicient  to  prove  that  it  is  by  the  vas 
deferens  that  the  inflammation  reaches  the  testicles,  because  it  is 
by  means  of  the  corpora  Highmoriana  that  the  secretory  tubes  open 
into  the  excretory  ducts.  It  is  not  then  surprising  that  this  part 
of  the  testicle  should  be  the  one  most  seriously  altered,  and  often 
even  the  only  one  aff"ected. 

Purulent  collections  formed  in  the  testicle  are  not  able,  like  those 
in  the  organs  we  have  already  considered,  to  empty  themselves  by 
the  excretory  canals,  and  the  fibrous  envelop  which  incloses  the 
secretory  vessels  is  very  resistant  ;  it  must,  therefore,  often  happen 
that  slight  and  very  circumscribed  inflammations  are  arrested  before 
suppuration  has  been  able  to  appear  externally.  If  in  these  cases 
complete  absorption  do  not  take  place  rapidly,  the  thicker  part  of 
the  pus  may  form  tubercles,  the  presence  of  which  will,  in  its  turn, 
be  a  cause  of  new  inflammation,  and  the  vessels  secreting  the  semen 
may,  like  the  follicles  of  the  prostate,  be  destroyed  by  degrees,  so 
that  the  gland  may  become  reduced  to  its  envelop  only.  Other 
products  besides  pus  may  be  formed  in  the  cellular  tissue  of  the  tes- 
ticle;  when  the  inflammation  is  slight,  but  of  long  duration,  or  fre- 
quently recurring,  a  gelatino-albuminous  matter  is  deposited,  which 
thickens  and  becomes  a  source  of  organic  alterations  like  those  in 
the  prostate,  and  the  first  cause  of  these  also  may  be  usually  traced 
to  long-neglected  chronic  aff'ections  of  the  urethra. 

I  have  attached  much  importance  to  the  thorough  understanding 
the  mode  of  transmission  of  inflammation  from  the  urethra  to  the 
testicles,  because  the  establishment  of  this  point  explains  in  the 
most  simple  way  why  the  presence  of  a  sound  in  the  urethra,  or  the 
existence  of  a  stricture,  so  often  excites  congestion  and  inflammation 
of  those  organs,  and  even  in  some  cases  the  development  of  hydro- 
cele, as  well  as  why  the  removal  of  the  cause  suffices  generally  to 
make  the  eff"ect  cease. 

The  conciliation  of  all  these  circumstances  is  especially  of  import- 
ance to  the  study  of  spermatorrhcEa ;  and  the  intimate  connection  of 
the  urethra  with  the  testicles  by  means  of  the  vasa  deferentia  should 
suffice  to  forewarn  us  of  the  influence  which  the  condition  of  the 
mucous  membrane  surrounding  the  orifices  of  the  ejaculatory  ducts, 
must  exercise  on  the  secretion  and  expulsion  of  semen. 

Urinary  Organs. — Analogous  phenomena  present  themselves  in 
the  organs  secreting  and  excreting  the  urine.  The  inflammation  ex- 
tends from  the  urethra  to  the  kidneys  by  means  of  the  bladder  and 
ureters  ;  it  is  even  easy  to  trace  its  progress,  without  interruption  ; 
hence  the  violet-colored  spots  of  congestion,  the  ecchymoses,  and 
even  ulceration  of  the  mucous  membrane  lining  these  organs ;  hence 
the  swelling  and  injection  of  the  kidneys;  hence  the  abscesses  of  all 


53  INFLAMMATION    OF    THE 

and  of  all  stages,  encysted  and  non-encysted,  and  mixed  with 


sizes 


crude  or  suppurating  tubercles,  which  have  been  found  in  the  kidneys. 
As  a  sequel  to  these  successive  attacks  of  inflammation,  1  have 
seen  the  tissue  of  the  kidney  destroyed  like  that  of  the  prostate  or  of 
the  testicle  ;  almost  reduced,  in  fact,  to  its  external  fibrous  envelop. 
There  is  then  an  exact  similitude  between  these  two  classes  of  or- 
gans, and  if  the  kidneys  could  be  as  easily  examined  as  the  testicles, 
this  resemblance  would  appear  still  more  strikingly. 

Ccmqyarison  of  the  Hvo  sets  of  Organs.— We  often  see,  after  expo- 
sure to  cold  or  excessive  drinking,  a  blennorrhagia  diminish  or  cease 
entirely,  and  the  patient  experience  at  the  same  time  violent  and 
deep-seated  pain  in  the  loins :  the  urine  is  scanty,  and  high  colored, 
and  sometimes  even  bloody.  If  in  these  cases  we  could  examine 
the  kidneys  as  we  do  the  testicles,  we  should,  perhaps,  find  that  at- 
tacks of  nephritis  following  blennorrhagia  are  nearly  as  frequent  as 
those  of  orchitis. 

I  am  convinced  that,  in  the  cases  I  have  seen,  alterations  of  the 
kidneys  have  been  more  frequent  than  those  of  the  testicles.  It  is 
not  only  as  a  sequel  to  blennorrhagia  or  stricture  that  nephritis 
takes  place ;  every  inflammation  of  the  urinary  canals  may  extend 
to  the  kidneys ;  and  this  is  why  acute  or  chronic  cystitis,  and  the 
presence  of  stone  in  the  bladder,  are  such  common  causes  of  inflam- 
mation of  these  organs ;  this  is  why  the  kidneys  are  so  often  found 
disorganized  when  the  bladder  has  been  long  irritated  by  the  presence 
of  extraneous  matters,  or  by  repeated  attacks  of  retention  of  urine. 
I  believe  I  have  now  more  than  sufficiently  shown  how  easily  acute 
inflammation  of  the  urethra  extends  to  the  secreting  organs  of  the 
semen  and  urine,  by  means  of  their  excretory  ducts  ;  I  have  com- 
pared together  the  phenomena  that  occur  in  both  classes  of  func- 
tions, because  they  are  presented  at  the  same  time,  in  very  nearly 
the  same  degree,  and  with  analogous  characters.  But  this  resem- 
blance is  not  observed  in  cases  of  acute  inflammation  only  ;  it  is 
more  easily  shown  in  these  cases,  and  on  this  account  I  have  com- 
menced with  their  consideration.  Similar  phenomena  are,  however, 
observed  under  the  influence  of  less  active  causes. 

When  the  bladder  is  irritated  the  secretion  of  urine  is  increased  in 
quantity  and  altered  in  quality ;  and  at  the  same  time  that  it  becomes 
more  abundant  and  more  watery,  it  remains  a  shorter  time  in  the 
bladder  ;  the  desire  of  micturition  is  felt  oftener  and  more  suddenly ; 
however  the  patient  may  wish  to  retain  the  excretion,  the  sensation 
is  so  painful,  and  the  bladder  contracts  so  violently,  that  the  urine  is 
often  expelled  in  spite  of  every  eff'ort,  and  before  the  patient  has  had 
time  to  prepare  himself  for  its  discharge.  The  fluid  is  passed  each 
time  in  small  quantity,  the  jet  is  short  and  feeble,  and  falls  within 
a  little  distance  of  the  patient's  feet:  should  this  state  continue  any 
length  of  time,  the  muscular  coat  of  the  bladder  becomes  more  deve- 
loped, the  parietes  of  the  organ  are  thickened,  and  its  capacity  dimi- 
nishes in  the  same  proportion.  Those  who  have  noticed  the  coinci- 
dence of  this  limpidity  of  the  urine  with  its  frequent  expulsion,  have 


SPERMATIC    ORGANS.  59 

concluded  that  the  more  watery  the  fluid  secreted  the  more  it  irritates 
the  mucous  membrane.  But  it  is  impossible  for  us  to  admit  that  the 
urine  should  irritate  the  bladder  most  when  it  contains  least  salts  in 
solution.  It  is  evident  that  the  effect  has  here  been  mistaken  for 
the  cause.  It  is  because  the  bladder  is  irritable  that  it  cannot  longer 
bear  the  presence  of  the  urine,  and  this  fluid  is  more  watery,  because 
the  irritable  kidneys  secrete  it  in  greater  quantity,  and  it  remains  a 
shorter  time  in  the  bladder  ;  that  this  view  is  correct,  is  proved  by 
the  vesical  mucous  membrane,  when  it  possesses  its  normal  sensi- 
bility, submitting  for  a  long  time  to  the  presence  of  a  large  quantity 
of  watery  urine,  as  occurs  daily  after  meals. 

If  this  irritation  be  prolonged,  it  may  produce  in  the  end  a  kind 
of  relaxation  of  the  secreting  vessels,  and  degenerate  into  diabetes. 
The  urine  entirely  loses  its  chemical  characters  ;  the  urea  and  uric 
acids  are  replaced  by  a  saccharine  matter,  and  the  system  wastes  in 
consequence  of  furnishing  so  superabundant  a  secretion. 

Exactly  the  same  phenomena  are  observed  in  the  spermatic  organs 
when  they  are  submitted  to  the  influence  of  a  similar  irritation  ;  the 
testicles  secrete  an  increased  quantity  of  semen  because  they  are 
irritated,  and  their  secretion  is  more  watery,  because  it  is  less  per- 
fectly formed,  and  remains  a  shorter  time  in  its  reservoirs  before 
expulsion ;  it  is  more  rapidly  expelled  because  the  seminal  vesicles 
are  more  sensitive  to  the  impression  produced  by  its  presence,  and 
are  more  readily  excited  to  action. 

The  spasmodic  contractions  of  which  these  organs  become  the  seat 
commence  by  producing  ejaculation  very  rapidly  either  during  sexual 
intercourse  or  after  erotic  dreams ;  this  renders  coitus  rapid  and  in- 
complete, and  nocturnal  pollutions  very  frequent ;  afterwards  the 
weakness  and  irritability  are  increased,  the  semen  becomes  more 
abundant,  and  still  more  fluid,  and  the  convulsive  contractions  of  the 
seminal  vesicles  are  more  frequent;  during  this  state  the  approach  of 
a  female,  or  even  a  lascivious  idea  may  suffice  to  excite  ejaculation  ; 
but  the  semen  is  no  longer  projected  with  energy,  erection  is  never 
complete,  and  scarcely  any  sensation  nccompanies  emission. 

These  injurious  contractions  are  at  last  excited  even  by  still  less 
distinct  causes ;  the  patients  feel  them  come  on  when  least  expected, 
they  dread  their  consequences,  and  still  they  are  quite  unable  to 
prevent  them.  Lastly,  there  are  cases  in  which  the  debility  of  the 
genital  organs  is  such  that  a  true  spermatic  diabetes  may  be  said  to 
be  present,  as  well  by  the  quantity  and  quality  of  the  secreted  fluid 
as  by  the  frequency  of  its  emission. 

We  have  been  unable  to  make  the  same  chemical  experiments 
on  the  altered  semen  that  have  been  made  on  the  urine  of  diabetic 
patients ;  but  the  semen  in  such  cases  contains  no  more  spermatozoa 
than  the  urine  does  urea.  Let  it  not  be  thought  that  this  statement 
is  founded  only  on  analogy ;  the  fact  really  exists  in  practice.  I  have, 
at  this  moment,  a  patient  under  my  care,  who  is  dying,  worn  out  by 
the  effects  of  diabetes  with  diurnal  pollutions  of  the  same  kind. 


50  INFLAMMATION    OF    THE 

Here  then,  we  have,  from  the  action  of  the  sancie  causes,  the  kid- 
neys, testicles,  bladder,  and  seminal  vesicles  affected  in  the  same 
manner,  and  producing  analogous  results  ;  and  further,  these  affec- 
tions seldom  occur  singly ;  thus,  in  stricture,  the  urinary  passages 
are,  indeed,  chiefly  affected,  but  I  have  seen  cases  in  which  the 
spermatic  organs  have  been  almost  as  much  disordered  ;  it  is  not  in- 
flammation alone  which  may  extend  in  both  these  directions,  but 
even  a  simple  irritation  of  the  urethral  mucous  membrane. 

Diurnal  pollutions  are  too  little  understood  to  have  been  generally 
noticed  in  these  cases;  they  are  always  obscure,  and  the  attention  is 
fixed  usually  on  another  object ;  but  I  have  so  often  satisfied  myself 
of  their  presence  as  a  sequel  to  strictures,  that  I  regard  sperma- 
torrhoea as  the  true  cause  of  all  the  cases  of  hypochondriasis,  ischuria, 
and  debility,  which  are  attributed  to  affections  of  the  urinary  organs. 
This  position  is,  I  think,  proved  by  the  weakness  and  rare  occurrence 
of  erection,  the  rapidity  of  ejaculation,  and  the  increased  fluidity  of 
the  semen  observed  in  most  of  these  patients. 

Cases  of  diurnal  pollution  uncomplicated  with  chronic  catarrh  or 
irritation  of  the  bladder  are  sometimes  rare ;  and  this  often  renders 
diagnosis  difficult,  not  only  on  account  of  the  symptoms  of  catarrh 
being  present,  but  also  on  account  of  the  mucus  secreted  by  the 
bladder  and  prostate.  On  this  account,  when  I  see  the  urine  cloudy, 
I  always  inquire  respecting  diurnal  pollutions,  so  that  I  may  not 
confound  mucus  with  semen. 

It  is  very  remarkable,  also,  that  those  who  give  themselves  up  to 
venereal  excesses  or  masturbation,  frequently  experience  a  desire 
to  micturate ;  this  fact  gave  rise  to  the  saying  of  the  ancients, 
^'' raro  mingitur  castus."  I  have  ever  been  struck  by  the  truth  of 
this  axiom  ;  and  the  fact  proves  how  easily  the  urinary  organs  share 
the  excitement  of  the  spermatic. 

Another  very  important  circumstance  in  the  history  of  diurnal 
pollutions  proves  how  correct  is  the  analogy  I  have  established  be- 
tween irritation  of  the  bladder  and  that  of  the  seminal  vesicles.  It 
is  almost  always  at  the  end  of  the  emission  of  urine  that  the  semen 
escapes ;  the  bladder  then  contracts  forcibly  to  expel  the  last  drops 
of  urine,  and  the  seminal  vesicles  also  enter  into  action,  and  expel 
with  the  urine  a  greater  or  less  quantity  of  their  contents. 

It  has  been  wrong  to  attribute  this  viscid  discharge  to  the  prostate, 
because  it  does  not  present  all  the  qualities  of  ordinary  semen  ;  the 
evacuation  is  sometimes  very  abundant,  and  that  it  is  semen,  cannot, 
in  these  cases,  be  mistaken.  Besides  this,  when  the  patients  have 
their  attention  called  to  the  circumstance,  they  know  very  well  how 
to  estimate  the  contractions  of  the  seminal  vesicles,  which  are  even 
in  general  proportion  to  the  extent  of  the  evacuation. 

Most  patients  remark  also  that  when  they  are  threatened  with  a 
relapse,  it  is  preceded  by  a  more  frequent  and  very  sudden  desire  to 
micturate,  whether  this  increased  sensibility  of  the  bladder  arise  from 
cold  or  from  an  excess  either  of  drink  or  of  coitus.  This  proves  that 
the  same  causes  act  at  once  on  both  sets  of  orsans. 


SPERMATIC    ORGANS.  61 

Persons  affected  by  diurnal  pollutions  experience,  generally,  in- 
jurious effects  from  the  use  of  diuretics.  Nearly  all  those  who  have 
taken  squills,  nitrate  of  potass,  digitalis,  &c.,  have  noticed  during 
their  use  a  remarkable  increase  of  the  seminal  evacuations,  and  a 
few,  after  having  been  cured  during  a  longer  or  shorter  period,  have 
experienced  relapses  which  could  not  be  attributed  to  any  other  cause, 
and  which  have  spontaneously  passed  off  as  soon  as  they  have  relin- 
quished the  use  of  these  medicines. 

It  is  also  well  worthy  of  notice  that  children  subject  to  incontinence 
of  urine,  are  particularly  liable  to  nocturnal  pollutions  at  the  age  of 
puberty  ;  and  at  a  later  period  to  diurnal  pollutions. 

Lastly,  I  cannot  conclude  this  parallel  of  the  two  sets  of  organs 
without  mentioning  that  obliteration  of  the  spermatic  excretory 
ducts  may  be  followed  by  the  formation  of  spermatic  fistul;©,  in 
the  same  manner  that  strictures  of  the  urethra  give  rise  to  urinary 
fistulge. 

To  resume  : — All  the  mucous  surfaces  of  the  genito-urinary  organs 
have  the  greatest  analogy  and  the  most  intimate  connection  with  one 
another.  It  is  by  them  that  inflammation  creeps  by  degrees  to  the 
secreting  organs  of  the  urine  and  of  the  semen.  The  portion  of  this 
membrane  which  lines  the  prostate,  being  in  intimate  connection  with 
that  of  the  mucous  follicles,  with  that  of  the  ejaculatory  ducts,  and 
with  that  of  the  bladder — this  portion  then  is  the  one,  the  different 
conditions  of  which  have  most  effect  on  all  the  rest.  This  connection 
takes  place  by  means  of  the  lining  membrane  of  the  ducts ;  and  is 
by  no  means  to  be  considered  the  result  of  sympathy,  such  as  exists 
between  the  uterus  and  breasts. 

The  excretory  canal,  transmitting  the  inflammation,  must  neces- 
sarily share  its  influence.  The  seminal  ducts  and  vesicles,  then, 
cannot  remain  unaffected  by  the  action  they  transmit  to  the  testicles, 
and  this  is  an  important  consideration  when  we  recollect  that  these 
are  as  much  the  acting  organs  in  the  emission  of  semen,  as  the  blad- 
der is  the  organ  for  the  expulsion  of  urine. 

We  shall  often  find  it  necessary  to  apply  these  facts  to  the  study 
and  treatment  of  diurnal  pollutions,  and  in  passing,  it  is  as  well  to 
notice  that  the  influence  of  the  excretory  canals  on  the  secreting 
organs  is  not  an  isolated  phenomenon  occurring  only  in  the  kidneys 
and  testicles,  but  that  it  is  the  result  of  a  general  law,  applicable  to 
all  glands. 

Suction  excites  the  secretion  of  milk  and  changes  its  qualities  ; 
the  first  drops  drawn  from  the  nipple  are  watery,  and  the  milk 
afterwards  becomes  more  abundant  and  better  formed  in  proportion 
as  the  suction  continues.  The  introduction  of  extraneous  bodies 
between  the  eyelids  increases  the  lachrymal  secretion,  which  some- 
times even  is  so  changed,  that  it  irritates  and  excoriates  the  skin 
of  the  cheeks.  The  presence  of  food  in  the  mouth,  especially  when 
spiced  and  savory,  increases  the  secretion  of  the  salivary  glands. 
During  digestion  the  liver  and  pancreas  are  excited  ;  and  the  use  of 


g2  CAUSES    OF 

emetics  and  purgatives  produces  the  same  effects.  The  ejaculatory 
ducts  open  on  the  surface  of  the  prostatic  mucous  membrane  ;  is, 
then,  the  important  part  this  membrane  plays  in  the  production  of 
spermatorrhoea,  a  cause  for  wonder  ? 


CHAPTEH    III. 

CAUSES  OF  SPERMATORRHCEA. 
Blennorrhagia. 

The  first  case  of  diurnal  pollutions  which  I  had  occasion  to  treat 
occurred  in  a  student  of  medicine,  twenty  years  of  age,  who  studied 
his  disease  with  much  care,  and  described  its  causes  and  symptoms 
with  remarkable  perspicuity.     The  following  are  the  facts: — 

CASE  V. 

Li/mphatic  temperament — Blennorrhagia — Orchitis — Nephritis — Nocturnal 
and  diurnal  poUutions — Abuse  of  mercurials — Injurious  effects  of  colds 
and  tonics — Cure  hy  means  of  leeches,  the  use  of  Jlannel,  and  milk  diet — 
Fresh  attacks  of  Blennorrhagia — Same  treatment,  with  the  same  result. 

M.  N ,  of  lymphatic  temperament,  tall  and  thin,  with  a  pale  face,  red 

hair,  white,  and  habitually  cold  skin,  narrow  chest,  and  soft,  feeble  voice, 
had  never  suffered  from  any  diseases  except  those  about  to  be  described.    In 

January,  1821,  M.  N contracted  blennorrhagia,  which  was  treated  by 

emollient  drinks,  general  baths,  and  corrosive  sublimate.  In  the  month  of 
April,  several  doses  of  Chopart's*  mixture  were  taken,  and  arrested  the  dis- 
charge, after  a  duration  of  four  months.  Six  weeks  afterwards  he  contracted 
a  second  blennorrhagia,  and  in  September,  swelling  of  the  left  testicle 
occurred  after  horse  exercise.  This  swelling  was  in  a  great  measure 
dispersed,  but  a  flaccid  state  of  the  scrotum  remained,  causing  painful  drag- 
ging pains  in  the  spermatic  cords,  which  were  relieved,  however,  by  the 
use  of  a  suspensory  bandage.  At  the  commencement  of  1822,  the  dis- 
charge still  continuing,  local  astringents  and  mercurial  frictions  were  em- 
ployed,  with   iodide   of  potassium  and  bichloride  of  mercury  internally. 

1  The  following  is  the  composition  of  Chopart's  mixture : — 

"Sf.. — Balsam  copuib., 

Alcoholis,  sp.  gr.  33°, 
Syrupi  simplicis, 
Aq.  menth.  pip., 

Aq.  flor.  aurant.,  aa  partes  sexaginta; 
Sp.  Eether.  nitr.  partes  octo. 
M.  ft.  mist,  cujus  cochlear,  minim,  unum  nocte  maneque  summend. 


1 


SPERMATOKRHOEA.  63 

Under  this  treatment  the  discharge  diminished,  but  did  not  entirely  disap- 
pear. 

Whilst  taking  these   remedies,  M.  N was  exposed  to  severe  cold. 

Cutaneous  exhalation  was  suppressed,  and  pain  in  the  loins  supervened. 
This  was  generally  of  a  dull  character,  but  was  rendered  acute  on  the 
least  exposure  to  cold;  about  the  same  period  M.  N 's  digestion  be- 
came impaired.  He  attributed  this  to  weakness  of  the  stomach,  and  sought 
to  stimulate  the  organ  by  a  generous  diet,  and  by  the  use  of  rhubarb  and 
wine.  These  means,  however,  only  increased  his  disorder,  and,  about  the 
month  of  June,  1822,  it  became  very  serious.  As  soon  as  food  reached 
the  stomach  he  felt  an  impression  at  the  praecordia,  with  difficulty  of  breath- 
ing, general  lassitude,  and  sometimes  a  desire  to  vomit ;  his  tongue  was 
white  and  pasty ;  his  bowels  constantly  distended  with  flatus,  and  he  suf- 
fered from  obstinate  constipation,  with  occasionally  slight  fainting  fits  ; 
he  was  quite  unable  to  fix  his  attention  on  any  subject  requiring  mental 
exertion. 

Although  without  appetite,  he  forced  himself  to  eat  to  keep  up  his  strength, 
but  his  digestion  became  more  difficult,  and  he  felt  himself  much  overcome 
by  lassitude  after  meals.  He  endeavored  to  assist  digestion  by  the  use  of 
coffee,  and  with  the  same  view  he  bathed  every  morning  in  cold  water;  he 
was,  however,  unable  to  remain  immersed  more  than  a  quarter  of  an  hour  at 
a  time  without  shaking  in  all  his  limbs ;  no  reaction  took  place  afterwards, 
and  he  always  remained  a  long  time  before  he  was  able  to  regain  a  comfort- 
able degree  of  warmth.  He  obtained  relief  from  eating  ices,  however,  and 
took  them  frequently. 

A  slight  urethral  discharge  still  continued,  and  on  waking  in  the  morn- 
ing he  perceived  a  viscid  pearly  matter  at  the  orifice  of  the  glans.  Part  of 
this  matter,  remaining  in  the  canal,  was  expelled  with  the  urine,  and  re- 
mained suspended  in  the  fluid  like  a  cloud,  which  after  some  time  was  de- 
posited on  the  bottom  of  the  utensil. 

Towards  the  close  of  the  year  1822,  when  the  cold  weather  commenced, 
his  bad  symptoms  increased ;  he  became  sad  and  absent,  was  unsettled,  with- 
out fixed  motives,  and  very  timid.  He  became  shivered  on  the  least  expo- 
sure to  cold,  the  rigor  commencing  in  the  lower  extremities,  and  extending 
over  the  whole  body.  He  suffered  severe  pains  in  the  loins,  and  passed 
urine  frequently,  and  he  now  had  difficulty  in  expelling  the  last  drops,  which 
were  viscid  and  always  partly  passed  on  his  shirt.  He  no  longer  had  erec- 
tions or  sexual  impulse.  He  often  passed  semen  during  sleep,  without  las- 
civious dreams  or  any  turgidity  of  the  penis,  and  he  constantly  felt  an  irre- 
sistible drowsiness.  Towards  the  commencement  of  1823  he  perceived  an 
abundant  reddish  sediment  in  his  urine. 

About  the  end  of  February  his  state  had  become  deplorable :  he  then  ap- 
plied to  me,  and  I  ordered  the  following  treatment — twelve  leeches  to  tho 
anus,  cold  lotions  to  be  applied  to  the  scrotum  and  perineum  three  times  a 
day,  iced  milk,  flannel  next  the  skin,  very  little  wine  to  be  taken  with  his 
meals,  and,  after  a  short  time,  complete  abstinence  from  all  fermented  liquors. 
A  few  days  after  he  felt  a  remarkable  change ;  his  digestion  was  performed 
better;  the  pain  in  his  loins  and  the  lassitude  disappeared.  He  became 
less  sad,  less  timid,  and  he  applied  himself  to  study  with  ardor ;  his  genital 
organs  acquired  energy,  and  he  threw  aside  his  suspensory  bandage  ;  his 
urine  no  longer  deposited  a  sediment,  and  erections  reappeared.  Leeches 
were  applied  a  second  time,  fifteen  days  after  the  first,  and  he  continued 


g4  CAUSES    OF 

the  remainder  of  the  treatment  for  two  months.  By  that  time— about  the 
end  of  April— his  health  was  re-established,  and  the  warmth  of  summer 
proved  sufficient  to  confirm  it.  In  the  month  of  July,  1823,  however,  he 
contracted  a  third  blennorrhagia  which  did  not  affijct  his  general  health.  A 
month  after  its  appearance  it  was  treated  successfully  by  means  of  leeches 
and  small  doses  of  copaiba :  but  when  he  took  the  latter  in  too  large  quan- 
tities he  suffered  acute  pain  in  the  loins.     Sea  bathing  during  the  month  of 

September  contributed  much  to  strengthen  the  genital  organs.     M.  N 

was  afterwards  appointed,  by  concours,  senior  surgeon  to  a  very  important 
hospital,  which  proves  that  he  was  able  to  apply  himself,  after  his  recovery, 
to  severe  study.  I  have  since  seen  him  several  times,  and  have  learned  that 
his  health  continues  excellent,  but  that  he  is  obliged  to  guard  carefully 
against  the  effects  of  cold,  and  against  every  over  excitement  of  the  diges- 
tive organs.  He  finds  it  necessary  every  winter  to  return  to  milk,  with  mild 
and  light  food,  and  to  drink  water  with  his  meals. 

This  patient  while  suffering  under  blennorrhagia  used  horse  exer- 
cise ;  soon  afterwards  orchitis  occurred ;  painful  dragging  sensations 
were  experienced  in  the  spermatic  cords,  even  for  a  long  time  after 
the  abatement  of  the  inflammation.  It  was  then  by  the  vas  deferens 
that  the  inflammation  was  transmitted  from  the  mucous  membrane  of 
the  urethra  to  the  testicle.  A  short  time  after  from  exposure  to  cold, 
perspiration  became  suppressed,  and  pain  in  the  loins  was  experi- 
enced. This  pain  was  probably  situated  in  the  secreting  organs  of 
the  urine ;  since,  simultaneously,  its  emission  became  very  frequent, 
the  last  drops  were  expelled  with  difficulty,  and  its  composition  was 
much  altered.  The  inflammation  then  extended  by  means  of  the 
bladder  from  the  urethra  to  the  kidneys,  in  the  same  manner  that  it 
extended  by  the  vasa  deferentia  to  the  testicles. 

The  urine  deposited  an  abundant  gravelly  sediment,  and  at  the 
same  time  contained  semen  in  suspension.  The  bladder  had  become 
more  sensitive  to  the  presence  of  urine,  for  the  desire  to  empty  it  was 
often  and  very  suddenly  renewed.  The  seminal  vesicles  were  exactly 
in  the  same  condition,  and  the  semen  was  passed  without  erection 
during  sleep ;  in  addition  to  which,  the  contractions  of  the  bladder 
necessary  for  the  expulsion  of  the  last  drops  of  urine  caused  con- 
tractions in  the  seminal  vesicles,  and  the  fluid  expelled  was  viscid  and 
glairy.  Both  classes  of  symptoms  ceased,  reappeared,  and  were 
cured  at  the  same  time ;  and  they  were  evidently  due  to  a  state  of 
inflammation,  for  the  antiphlogistic  treatment  was  the  only  one  that 
succeeded  in  removing  them. 

The  injurious  eflfects  of  cold  were  very  evident  in  the  case  of  M. 

N ,  and  may  be  attributed  partly  to  his  lymphatic  temperament, 

but  we  often  find  analogous  phenomena  in  patients  of  a  very  diS"erent 
constitution.     However  this  may  be,  I  am  convinced  that  without 

the  habitual  use  of  flannel  next  his  skin,  M.  N would  not  have 

been  able  to  preserve  himself  from  further  relapses,  or  permanently 
to  strengthen  his  constitution. 

^^'  ^ liad  undergone  several  courses  of  anti-venereal  treat- 


SPERMATORRHCEA.  65 

ment,  although  he  had  only  suffered  from  blennorrhagia,  and  the  ef- 
fects of  mercury  were  very  injurious  to  him,  as  his  constitution  was 
little  fitted  to  withstand  its  action.  He  fell  also  into  other  very 
common  errors,  which  are  the  ordinary  result  of  an  almost  universal 
false  reasoning  on  the  part  of  the  sick.  Perceiving  that  he  lost  flesh, 
he  ate  heartily,  and  chose  the  most  nutritious  kinds  of  food :  diges- 
tion being  performed  badly,  and  accompanied  with  the  development 
of  flatus,  because  the  stomach  shared  the  general  weakness,  he  had 
recourse  to  rhubarb,  generous  wines,  and  spices.  Hence  frequentlv 
arise  the  attacks  of  chronic  gastritis,  which  so  constantly  accompany 
old  cases  of  spermatorrhoea. 

M.  N 's  intellectual  functions  were  weak  in  common  with  the 

rest ;  he  was  habitually  drowsy,  and  he  took  cofiee  and  tea  to  rouse 
himself. 

At  length  M.  N ,  like  many  other  practitioners,  began  to  treat 

symptoms,  and  allowed  himself  to  be  influenced  by  the  names  given 
to  medicines  ;  his  urine  was  thick,  deposited  a  sediment,  and  was 
passed  with  difficulty ;  he  took  nitrate  of  potass  as  a  diuretic,  with- 
out reflecting  that  the  increase  of  secretion  which  this  medicine  pro- 
duces, is  the  result  of  excitement  of  the  urinary  organs,  and  that 
his  were  already  too  much  irritated.  His  bowels  being  constipated, 
he  took  purgatives  without  seeking  the  cause  of  constipation,  and 
without  troubling  himself  about  the  efiect  which  irritation  of  the 
rectum  produces  on  the  bladder,  the  prostate,  and  the  seminal  vesi- 
cles.    These  are  errors  of  daily  occurrence. 

The  abuse  of  cold  in  cases  of  nocturnal  and  diurnal  pollutions  is 
very  common.  By  bathing  in  the  river  M.  N followed  the  ad- 
vice laid  down  by  all  writers  on  the  subject:  it  proved  injurious  to 
him,  however,  because  the  genito-urinary  mucous  membranes  were 
too  irritable  not  to  receive  a  hurtful  shock  from  immersion  in  cold 
water.  The  patient  should  have  foreseen  this  result  from  the  bad 
effects  cold  had  always  produced  on  him ;  besides  this,  he  was  too 
weak  to  obtain  a  proper  degree  of  reaction  after  bathino-.  I  shall 
show  by  and  by  that  cold  baths  employed  without  distinction  in  cases 
of  spermatorrhoea,  have  done  much  more  harm  than  good.  Still  the 
patient  found  that  sea-bathing  at  a  later  period  gave  tone  to  his  o-eni- 
tal  organs,  and  he  was  unable  to  reconcile  two  efiects  of  so  opposite 
a  nature ;  yet  nothing  is  more  simple.  When  he  took  sea-baths  he 
was  cured ;  the  irritation  of  the  organs  had  passed  off",  and  their 
normal  condition  had  returned  ;  the  first  shock  of  the  cold  then  was 
no  longer  injurious,  and  the  consecutive  reaction  followed  rapidly. 
It  is  true  that  considerable  diff"erence  exists  between  sea  and  river 
bathing ;  but  it  is  chiefly  to  the  difi'erent  states  of  the  system  that 
the  two  very  opposite  eS"ects  of  cold  on  this  patient  must  be  referred. 

From  not  having  attended  to  this  important  distinction,  general 
directions  have  been  given  respecting  the  use  of  these  powerful 
agents — directions  which  daily  lead  to  the  most  disastrous  results. 


CAUSES    OF 


CxiSE  VI. 


Masturhation — Blennorrhngia — Diurnal  pollutions — Failure  of  the  ordi- 
nary  modes  of  treatment — Cauterization  of  the  prostatic  portion  of  the 
urethra — Rapid  recovery. 

Alexis  Poit,  set.  20,  short,  stout,  and  of  a  sanguineous  constitution,  ap- 
plied at  the  Hotel  Dieu,  Moutpellier,  to  be  cured  of  a  venereal  taint,  which, 
he  said,  existed  in  his  system,  in  consequence  of  an  attack  of  blennorrhagia 
contracted  three  months  previously,  and  cured  in  a  few  days  by  the  simple 
use  of  dandelion  tea. 

Nothing  in  the  appearance  of  the  patient  confirmed  this  statement.  He 
complained,  however,  of  violent  pain  in  his  head,  pain  in  his  bones,  frequent 
spasmodic  tremors  in  his  limbs,  and  a  constant  agitation  which  prevented 
his  enjoying  an  instant's  sleep;  of  stunning  sensations  and  vertigo,  with 
ringing  in  his  ears ;  of  a  sense  of  suffocation  with  palpitation  of  the  heart, 
and  of  itching  in  the  skin :  his  eyes  were  injected,  dry,  and  very  sensitive 
to  the  impression  of  light. 

Out  of  all  his  symptoms,  the  ossific  pain  was  the  only  one  that  could  fa- 
vor the  idea  of  a  venereal  taint ;  the  patient  said  that  he  suffered  most 
during  the  night,  but  his  answers  were  very  obscure  and  often  contradictory. 
His  skin,  however,  was  hot  and  dry,  and  covered  with  pimples.  I  prescribed 
for  him  venesection,  baths,  and  refrigerant  drinks. 

The  next  and  following  days,  discharges  occurred,  and  he  seemed  still 
more  satisfied  that  he  labored  under  a  syphilitic  taint.  His  constitution 
seemed  strong,  and  his  appearance  proclaimed  health.  I  thought,  therefore, 
at  first,  that  he  had  some  motive  for  feigning  various  diseases,  but  as  he 
did  not  eat,  and  seemed  inclined  to  suJbmit  to  moxas  and  other  means  of 
the  same  nature,  I  observed  him  more  closely.  The  pupils  looked  on  him 
as  a  hypochondriac  or  a  maniac,  because  he  complained  of  a  fixed  pain  in 
the  hypogastrium,  although  his  tongue  was  neither  red  nor  dry  ;  and  be- 
cause he  said  he  heard  a  continual  noise  in  his  belly,  and  felt  a  hand  of 
iron  pressing  on  his  intestines  for  several  hours  together,  and  then  relaxing 
them  suddenly. 

When  this  oppression  came  on,  he  felt  something  ascending  from  the  epi- 
gastrium that  almost  suffocated  him,  and  ceased  suddenly  on  his  passing 
flatus.  He  was  habitually  costive,  his  feces  were  very  offensive.  He  passed 
water  very  often,  and  complained  of  pain  in  the  penis  and  bladder  during 
micturition  ;  this  he  attributed  to  the  suppression  of  the  blennorrhagic  dis- 
charge. Twelve  leeches  were  ordered  to  the  anus,  with  general  baths,  which 
relieved  the  pains  in  the  bladder  and  penis, 

_  I  advised  the  patient  to  get  up  and  take  exercise,  but  he  pretended  that 
his  legs  were  unable  to  support  him,  and  he  spent  all  his  time  with  his 
head  under  the  bedclothes,  groaning  and  sighing. 

Having  observed  many  of  these  symptoms  in  persons  suffering  from  sper- 
matorrhoea, I  questioned  Poit  on  this  subject;  but  he  had  never  noticed 
any  discharge  resembling  semen,  either  while  passing  urine  or  feces.  He 
had  never  had  intercourse  with  any  female,  except  her  from  whom  he  had 
contracted  blennorrhagia,  and  with  her  very  rarely,  and  at  very  distant  in- 
tervals. 

From  the  way  he  deplored  the  moment  of  folly   to  which  he  owed  his 


SPERMATORRHOEA.  67 

sufferings,  I  suspected  that  he  had  been  addicted  to  masturbation  :  be  de- 
nied it  obstinately,  however,  before  the  pupils,  but  he  told  me  privately  that 
he  had  practised  it  from  the  age  of  ten,  even  five  or  six  times  a  day  :  at 
first  he  experienced  a  very  lively  tickling  sensation,  accompanied  by  dis- 
charge, and  soon  changing  into  a  painful  sense  of  burning.  About  the  age  of 
twelve,  having  perceived  that  those  injurious  practices  injured  his  health,  he 
became  more  careful ;  but  about  fourteen  he  again  gave  himself  up  to  the 
vice  almost  madly.  The  irritation  was  now  often  carried  so  far  as  to  produce 
pain  ;  the  veins  of  the  spermatic  cords  swelled,  and  there  existed  in  his  whole 
body,  especially  in  his  loins  and  joints,  a  sense  of  debility,  attended  by  ob- 
tuse pain.  He  had  continual  vertigo,  with  noise  in  his  ears,  and  his  me- 
mory became  impaired.  From  sixteen  to  eighteen  he  restrained  himself  by 
degrees,  and  regained  his  strength  and  stoutness.  At  this  time  he  first  had 
sexual  intercourse,  soon  after  which  blennorrhagia  came  on. 

I  requested  the  patient  to  preserve  his  urine,  and  to  notice  carefully  what 
passed  from  the  penis  when  he  was  at  stool.  I  found  the  urine  red,  thick, 
and  muddy,  with  a  flaky  cloud  suspended  in  it ;  the  sides  of  the  vessel  were 
lined  by  a  brick-dust-like  powder,  and  a  glairy  and  tenacious  sediment  was 
adherent  to  its  bottom.  The  patient  noticed  that  the  last  drops  of  urine 
were  thick  and  viscid,  and  were  passed  with  sudden  and  involuntary  con- 
tractions of  the  bladder.  After  passing  feces  he  found  a  thick,  granular, 
and  transparent  matter  at  the  orifice  of  the  urethra. 

I  prescribed  for  him  milk  three  times  a  day,  taken  as  cold  as  possible, 
and  mixed  with  Eau  de  Spa  or  lime-water ;  a  vegetable  diet ;  two  cold  hip- 
baths daily,  each  of  a  quarter  of  an  hour's  duration ;  and  a  cold  enema 
night  and  morning,  to  facilitate  the  passage  of  the  feces. 

These  means  which  I  had  seen  recommended  by  Wickman  and  Saint 
Marie,  and  which  had  succeeded  in  other  cases,  did  not  produce  any  im- 
provement in  this.  The  patient  became  more  restless  and  hypochondriacal, 
and  did  not  sleep  an  hour  during  the  night.  Emollients  and  leeches  re- 
lieved his  pain,  but  at  the  same  time  relaxed  his  system ;  he  suffered  less, 
but  he  passed  much  more  semen.  Tonics  and  cold  diminished  for  a  time 
the  seminal  discharge,  but  they  increased  the  pain  and  irritation. 

After  about  three  weeks  of  these  fruitless  essays,  I  gave  up  general  means 
altogether,  and  as  I  was  convinced  that  the  spermatorrhoea  arose  from  a 
state  of  chronic  inflammation  of  the  prostatic  mucous  membrane,  the  irrita- 
tion of  which  extended  to  the  ejaculatory  ducts  and  seminal  vesicles,  I  con- 
sidered that  by  removing  this  state  of  the  membrane  by  means  of  cauteri- 
zation, I  should  put  an  end  to  the  irritation  of  the  spermatic  organs,  and 
especially  to  the  spasmodic  contractions  of  the  seminal  vesicles. 

The  beneficial  effects  which  I  had  obtained  from  the  use  of  nitrate  of  sil- 
ver in  analogous  cases  of  irritation,  made  me  little  dread  the  danger  said  to 
be  attached  to  cauterization  of  the  prostatic  portion  of  the  urethra,  on  ac- 
count of  its  vicinity  to  the  bladder. 

In  order  to  empty  the  bladder,  and  to  take  the  exact  length  of  the  ure- 
thra, I  was  obliged  to  introduce  a  catheter,  which  had  scarcely  entered  an 
in'^h  or  two  into  the  canal,  when  violent  spasmodic  contractions  commenced, 
which  prevented  it  from  advancing,  and  almost  made  me  suspect  the  exist- 
ence of  stricture;  after  a  few  seconds  these  spasms  ceased,  and  the  cathe- 
ter passed  as  far  as  the  neck  of  the  bladder.  Here  the  pain  and  spasms 
were  redoubled,  and  the  bladder  seemed  perfectly  closed.  At  length,  after 
a  considerable  time,  I  was  enabled  to  introduce  the  point  of  the  catheter 


58  CAUSES    OF 

into  the  neck  of  tbe  bladder,  and  the  instrument  was  immediately  power- 
fully drawn  into  the  vesical  cavity,  as  though  by  a  kind  of  suction.  When 
untouched  the  catheter  was  several  times  suddenly  attracted  and  repelled 
alternately  by  the  convulsive  action  of  the  muscles  of  the  perineum_  and 
bladder  •  and  its  extraction  was  almost  as  painful  and  difficult  as  its  intro- 
duction had  been,  so  firmly  was  it  held  by  the  neck  of  the  bladder.  The 
vesical  contents  were  rapidly  and  forcibly  discharged. 

All  these  circumstances  confirmed  me  in  the  diagnosis  I  had  formed  re- 
specting the  cause  of  the  disease,  and  I  immediately  applied  the  solid  nitrate 
of  silver  to  the  prostatic  portion  of  the  urethra.  The  application  was  rapid- 
lasting  only  long  enough  to  incline  the  caustic  to  the  right  and  left,  so  as 
to  make  it  pass  quickly  over  the  inferior  surface  of  the  canal. 

During  the  first  twenty-four  hours,  the  patient  suffered  much  while  pass- 
ing urine.  On  the  second  day,  the  pain  was  much  less  severe,  and  on  the 
third  day,  it  was  scarcely  worth  notice.  During  these  three  days,  the  urine 
was  thick  and  muddy,  and  the  last  drops  were  streaked  with  blood.  ^  After 
this  time  it  became  transparent,  and  the  patient  was  able  to  retain  it  much 
longer. 

Twelve  days  after  the  cauterization,  the  urine  was  quite  normal,  without 
either  deposit  or  cloud — the  last  drops  were  expelled  easily,  and  were  as 
transparent  as  the  first.  The  patient  no  longer  experienced  tension  or  un- 
easiness in  the  perineum,  or  involuntary  contractions  of  the  neck  of  the 
bladder ;  but  when  the  bowels  were  confined,  he  still  noticed  a  viscid  matter 
at  the  orifice  of  the  urethra. 

The  first  improvement  noticed  was  in  his  sleep,  which  became  sounder 
and  longer;  then  the  moral  and  physical  man  became  more  energetic  ;  and 
lastly,  the  activity  of  the  digestive  organs  returned.  Within  fifteen  days 
erections  reappeared,  and  after  some  time  the  patient  experienced  noctur- 
nal pollutions,  preceded  by  erotic  dreams,  and  accompanied  with  lively 
sensations.  The  intellectual  powers  were  the  last  to  be  entirely  re-esta- 
blished ;  but  they  did  not  appear  to  have  ever  been  very  active  in  this 
patient. 

At  the  expiration  of  a  month,  his  health  was  quite  perfect,  and  he  wished 
to  resume  his  former  occupation. 

This  patient  was  the  first  on  whom  I  practised  cauterization  as  a 
remedy  for  spermatorrhoea  ;  and  I  have  related  his  case  chiefly  to 
show  the  active  and  painful  contractions  of  the  neck  of  the  bladder 
and  urethra  which  occur  in  such  cases.  These  facts  may  give  an 
idea  of  the  extreme  state  of  irritation  of  the  urethral  raucous  lining, 
and  of  the  influence  which  this  condition  must  exercise  over  the  se- 
minal vesicles. 

The  phenomena  above  described  are  very  often  observed  in  patients 
affected  by  spermatorrhoea  ;  their  study  is  therefore  important  in 
deciding  on  its  treatment — thus,  for  example,  I  have  noticed  that 
the  greater  the  state  of  irritation  the  more  certain  are  the  effects  of 
cauterization  ;  in  these  cases,  also,  tonics,  ice,  and  cold  hip-baths, 
are  by  no  means  proper.  In  the  case  I  have  just  related  sperma- 
torrhoea was,  without  doubt,  caused  by  the  blennorrhoea,  but  the 
excessive  masturbation  to  which  the  patient  had  been  addicted,  even 


SPERMATORRHEA.  69 

before  puberty,  must  have  contributed  much  to  produce  tbis  unfor- 
tunate disease,  and,  probably,  from  this  circumstance  it  arose  that 
a  cure  was  impossible  by  the  employment  of  the  usual  simple  means. 


CASE  yii. 

Abuse   of  spi'rihioiis    liquors — Blennorrhcujia — Xocturnal   Pollutions — Im- 
potency — Frequent  discharge  of  urine — Cauterization — Cure. 

J.  D at  an  early  age  accustomed  himself  to  an  excess  of  alcoholic 

drinks,  but  in  other  respects  was  remarkably  abstemious :  at  the  age  of 
twenty  he  contracted  blennorrhagia,  which  disappeared  of  its  own  accord 
at  the  end  of  about  three  weeks.  A  short  time  after  he  noticed  that  noc- 
turnal pollutions  occurred  very  frequently,  sometimes  happening  eight  or 

ten  nights  consecutively.     The  day  following  these  discharges  I) was 

depressed  in  spirits  and  suffered  from  headache,  noise  in  the  ears,  and  daz- 
zling before  the  eyes  :  these  sj-mptoms  induced  him  to  submit  to  venesec- 
tion three  times,  and  to  apply  leeches  to  the  temples,  after  which  D 

entirely  lost  all  virile  power. 

After  the  disappearance  of  the  blennorrhagia  a  yellowish  discharge  from 
the  anus  came  on  several  times,  and  was  accompanied  with  a  very  trouble- 
some itching.  Soon  after  this  the  patient  had  a  tetter  on  the  face,  for  which 
he  took  alteratives  and  mercurials.  The  skin  disease  disappeared,  but 
symptoms  of  irritation  of  the  bladder  supervened. 

In    1824,  D ,  aged  twenty-four,  came  to  the  hospital  of  St.  Eloi,  in 

the  following  state.  He  was  of  the  middle  height,  and  well  made,  his  skin 
was  pale,  his  hair  black,  his  face  very  red,  his  manner  gloomy  and  taciturn; 
he  was  fond  of  solitude,  showed  perfect  indifference  towards  women,  and 
great  horror  of  masturbation.  His  intellect  was  dull,  his  digestion  painful, 
and  his  limbs  weak.  He  passed  urine  two  or  three  times  an  hour  during 
the  day,  and  five  or  sis  times  in  the  course  of  the  night,  attended  by  scald- 
ing and  pain  in  the  canal. 

The  introduction  of  a  silver  catheter  of  moderate  size  excited  spasmodic 
contraction  and  acute  pain  in  the  neck  of  the  bladder,  which  induced  me 
to  propose  cauterization  to  the  patient :  he  agreed  to  it  without  hesitation, 
and  I  performed  it  immediately. 

I  introduced  the  caustic  holder  into  the  bladder  so  as  to  cauterize  the 
parts  near  its  neck,  and  I  passed  the  caustic  over  the  prostatic  surface  as 
well  as  over  the  membranous  portion  of  the  urethra  in  withdrawing  it.  Im- 
mediately afterwards  there  was  a  pressing  desire  to  micturate,  and  blood 
passed  with  the  urine.     Baths  and  barley-water  were  ordered. 

During  the  following  night  he  experienced  a  painful  seminal  emission  ; 
he  passed  urine  only  once,  but  with  an  acutely  burning  pain. 

On  the  following  day  the  patient  only  passed  urine  four  times,  but 
always  with  burning  and  a  slight  discharge  of  blood. 

On  the  third  day  he  no  longer  passed  any  blood,  and  the  scalding  was 
very  slight. 

On  the  fourth  day  the  emission  of  urine  took  place  every  three  cr  four 
hours  only,  and  the  discharge  arising  from  the  cauterization  had  ceased. 

On  the  following  days  emptying  the  bladder  was  performed  less  and  less 
frequently ;  seminal  discharge  no  longer  followed ;  the  patient  regained  his 
5 


70 


CAUSES    OF 


spirits;  his  health  became  perfectly  re-established,  and  about  the  fifteenth 
day  after  the  cauterization  he  left  the  hospital. 

In  this  patient  the  blennorrbagia  had  not  been  preceded  by  exces- 
sive sexual  intercourse  or  masturbation  ;  but  the  abuse  of  alcoholic 
stimulants  is  almost  as  pernicious  in  its  eflFects  on  the  genito-urinary 
organs ;  besides  this  he  possessed  a  strumous  habit,  which  showed  it- 
self by'  the  tetter  on  the  face  and  the  abscess  at  the  margin  of  the 
anus.  It  is  especially  in  cases  of  this  kind,  that  tonics,  ice,  and 
cold  bathing  fail,  and  are  even  injurious;  happily,  we  possess  a 
powerful  remedy  in  cauterization. 

In  this  case  the  tetter  on  the  face  having  disappeared,  infiamnia- 
tion  of  the  vesical  mucous  membrane  occurred ;  this  was  very  in- 
tense, the  patient  passing  urine  two  or  three  times  in  the  hour  ; 
from  this  time  the  urinary  symptoms  predominated,  on  which  ac- 
count catheterism  was  accompanied  with  acute  pain  in  the  prostatic 
region,  and  spasmodic  contractions  of  the  neck  of  the  bladder. 

Not  long  since  cauterization  of  the  prostatic  portion  of  the  urethra 
was  looked  on  as  the  extreme  of  rashness,  so  much  was  the  introduc- 
tion of  the  least  particle  of  the  nitrate  of  silver  into  the  bladder  dreaded ; 
although  these  fears  were  only  founded  on  argument,  they  were  gene- 
rally received,  and  seemed  so  natural  that  I  was  influenced  by  them 
for  several  years.  I  have  stated  in  another  place  the  means  by  which 
I  shook  off  these  foolish  fears,  and  the  successful  results  that  have 
followed  the  application  of  the  nitrate  of  silver  to  the  mucous  mem- 
brane of  the  bladder  in  catarrhal  affections  of  that  organ.'  Since 
that  time,  whenever  I  meet  with  cases  in  which  the  affection  of  the 
prostatic  mucous  membrane  extends  to  that  of  the  bladder,  I  begin 
by  cauterizing  the  latter,  and  I  continue  the  application  as  far  as  the  • 
bulb  of  the  urethra  whilst  withdrawing  the  instrument,  by  inclining 
it  rapidly  to  the  right  and  left.  It  is  not  to  take  the  length  of  the 
canal  that  I  introduce  a  catheter  in  these  cases,  but  in  order  to  empty 
the  bladder  completely,  so  that  the  nitrate  of  silver  may  act  with 
more  energy.  We  have  just  seen  the  effect  of  this  treatment :  a 
patient  who  previously  passed  urine  two  or  three  times  in  the  hour 
was  enabled  to  retain  the  excretion  as  long  as  is  usual,  and  at  the 
same  time  the  spermatorrhoea  from  which  he  suffered  was  cured. 

This  case  also  confirms  in  a  remarkable  manner  what  I  have  above 
stated  respecting  the  relations  that  exist  between  the  disease  of  the 
urinary,  and  those  of  the  spermatic  organs. 

'   Vide  Le9ons  de  Clinique,  &c. 


SPERMATORRHEA.  71 


CASE  VIII. 

Masturbation — Blennorrhagia,  repeated  anti-venereal  treatment — Diurnal 
pollutions — Increasing  iceakness,  especially  of  the  mental  faculties — Ex- 
treme emaciation — Cauterization,  and  cure  after  sixteen  years.  Venereal 
excesses,  relapse — Cauterization  again  performed  with  success. 

M.  V ,  of  spare  habit  and  nervous  temperament,  was  addicted  to  mas- 
turbation about  the  age  of  puberty,  but  abstained  when  he  perceived  his 
health  affected.  He  again  practised  it  as  soon  as  his  strength  began  to  re- 
turn, and  renounced  it  as  soon  as  he  perceived  his  health  endangered.  He 
again  regained  his  strength,  and  applied  himself  with  diligence  and  success 
to  the  study  of  law. 

At  the  age  of  eighteen  he  contracted  blennorrhagia,  which  was  treated 
during  sis  months  with  injections  of  acetate  of  lead,  sulphate  of  copper,  &c. 
The  discharge  disappeared  after  a  journey  on  horseback — again  came  on 
soon  after  and  again  stopped.  Urethral  discharge  was  afterwards  often  ex- 
cited by  very  slight  causes. 

Independently  of  tonics,  injections,  and  astringents,  which  were  prescribed 
for  this  patient  without  the  least  discretion,  bichloride  of  mercury,  mercurial 
pills,  sarsaparilla,  and  friction  with  mercurial  ointment,  were  recommended. 
His  health  became  more  and  more  disordered;  he  was  subject  to  headache 
and  pains  in  the  limbs  and  loins,  accompanied  with  debility,  loss  of  sleep, 
and  frequent  attacks  of  fainting. 

M.  V attributed  all  these  symptoms  to  the  presence  of  a  venereal 

virus  of  the  system,  and  as  they  increased  several  times  after  sexual  inter- 
course, he  was  persuaded  that  he  had  on  each  occasion  received  fresh  infec- 
tion. At  length  the  care  of  his  health  became  quite  a  kind  of  monomania. 
He  abandoned  the  career  he  had  followed  for  eight  years,  and  came  to 
Montpellier  to  study  medicine  for  the  sole  purpose  of  arriving  at  the  cause 
of  his  complaint,  and  finding  a  remedy  for  it.  Returning  always  to  the  idea 
of  a  syphilitic  virus,  he  submitted  himself  successively  to  all  the  anti- 
syphilitic  modes  of  treatment  he  could  discover  recommended  by  authors, 
and  combined  them  together  in  various  ways. 

Still,  however,  his  strength  diminished  by  degrees;  his  digestion  became 
painful  and  laborious;  and  he  was  annoyed  by  flatus  and  obstinate  constipa- 
tion, which  he  combated  by  the  frequent  use  of  purgatives.  His  intellect 
became  so  far  weakened  that  he  could  not  fix  his  attention  during  a  lecture, 
and  soon  even  he  became  unable  to  comprehend  what  he  read. 

He  attended  the  courses  of  the  faculty,  but  he  was  unable  to  remain 
during  half  a  lecture  without  experiencing  fatigue  and  impatience  :  his  head 
became  congested,  and  he  felt  a  constant  desire  to  change  his  position,  or  to 
walk. 

Though  formerly  competent  to  argue  with  pleasure  on  the  most  abstract 
propositions,  he  was  now  unable  to  follow  the  simplest  reasoning;  and  the 
most  recent  and  important  facts  escaped  his  recollection.  He  was  tor- 
mented by  attacks  of  vertigo,  loss  of  sight,  and  noise  in  the  ears.  The 
least  intellectual  excitement  induced  fits  of  pain  in  the  head;  and  slight 
congestions  were  often  excited  by  the  digestive  process,  by  flatulence,  or  by 
efforts  at  stool. 

The  patient  having  his  mind  continually  occupied  by  these  symptoms  at 


72  '  CAUSES    OF  ^ 

length  persuaded  himself  that  part  of  his  cerebral  substance  had  been  ab- 
sorbed and  that  his  cranium  only  contained  the  nerves  of  sense ;  he  thought 
ho  could  feel  these  bathed  in  serum,  and  he  was  obstinately  of  opinion  that 
he  was  threatened  with  an  attack  of  apoplexy. 

On  the  other  hand,  his  character  became  sad,  variable,  and  unsociable ; 
he  disliked  music,  of  which  he  had  previously  been  passionately  fond ;  he 
slighted  all  his  friends,  and  his  misanthropy  became  so  great  that  when  he 
an  acquaintance  in  the  street  he  turned  on  his  heel  in  order  to  avoid 


saw 


him.  Tormented  by  a  constant  desire  for  motion,  Ije  was  unable  to  remain 
long  in  the  same  place  ;  and  this  restlessness,  together  with  his  love  of  soli- 
tude, made  him  wander  constantly  in  all  the  by-ways  of  the  neighborhood 
of  Montpellier.  He  was  careless  of  everything,  and  often  in  distress  from 
having  neglected  his  affairs. 

At  length,  after  remaining  seven  years  at  Montpellier,  M.  V came  to 

consult  me.  From  the  first  words  he  said  to  me  I  suspected  that  he  suffered 
from  diurnal  pollutions,  and  I  questioned  him  closely  on  this  head ;  but  he 
had  never  noticed  spermatic  discharges  either  whilst  passing  urine  or  feces, 
and  he  persisted  in  the  opinion  that  his  disorder  arose  from  a  venereal  virus 
still  existing  in  his  system. 

A  short  time  afterwards,  to  relieve  an  attack  of  cerebral  congestion,  he 
applied  leeches  to  the  anus,  and  was  unable  to  leave  his  bed  for  three 
months. 

The  observations  he  made  during  this  period  convinced  him  that  my  dia- 
gnosis was  correct,  but  he  still  wished  to  treat  himself,  and,  among  other 
means,  placed  pounded  camphor  between  the  glans  penis  and  prepuce,  in 
order  to  act  directly  on  the  genital  organs :  a  few  hours  after,  on  going  to 
stool,  he  passed  a  large  quantity  of  semen,  fainted,  and  remained  some  time 
before  he  was  able  to  call  assistance. 

I  never  witnessed  a  more  repulsive  sight  than  that  I  saw  on  reaching  M. 

Y 's  residence ;  the  disorder  and  dirt  that  surrounded  him  evinced  the 

most  perfect  carelessness.  Muddy  urine,  of  a  fetid  smell,  filled  a  dirty  ves- 
sel placed  near  the  head  of  his  bed  on  a  chair  covered  with  dust  and  clothes. 
He  was  extremely  pale,  and  greatly  emaciated;  he  threw  himself  about  on 
his  bed  like  a  person  moribund ;  his  limbs  were  cold,  and  his  pulse  weak  and 
irregular. 

As  soon  as  he  was  able  to  understand  me,  I  proposed  cauterization  of  the 
prostatic  mucous  membrane  to  him  j  he  joyfully  consented,  and  I  performed 
it  the  same  day. 

The  moderate  sized  silver  catheter,  which  I  introduced  first  to  empty  the 
bladder,  excited  spasmodic  contractions  of  the  canal,  and  appeared  to  give 
considerable  pain,  especially  in  the  prostatic  region — further  confirming  me 
in  my  opinion  that  the  prostatic  portion  of  the  urethra  had  been  a  long  time 
the  seat  of  chronic  inflammation. 

The  application  of  the  caustic  presented  nothing  worthy  of  record. 
Two  days  after  the  operation,  the  patient  experienced  a  feeling  of  vigor 
in  the  genital  organs,  and  of  general  comfort  which  gave  him  hope.  Soon 
after  he  regained  his  spirits,  appetite  and  sleep  returned ;  his  voice  acquired 
strength  ;  he  felt  his  taste  for  music  return ;  he  sought  out  his  friends ;  his 
face  entirely  changed  its  expression,  and  his  mirth  became  even  boisterous. 
At  the  expiration  of  fifteen  days  from  the  operation  he  experienced  ve- 
nereal desires,  and  erections  were  frequent  and  energetic.  His  appetite  was 
good,  and  his  digestion  acted  with  an  unusual  energy. 


SPERMATORRHCEA.  73 

His  health  continued  to  progress  favorably  until,  to  hasten  his  restora- 
tion, he  introduced  a  paste  containing  acetate  of  lead  and  copaiba  into  the 
urethra.  After  this  the  spermatic  discharges  reappeared,  inflammation  ex- 
tended to  the  testicles,  and  suppuration  occurred  in  the  left,  notwithstand- 
ing active  measures.  An  ounce  of  pus,  which  seemed  to  me  to  be  dis- 
charged from  the  tunica  vaginalis,  followed  a  puncture  on  the  left  side ; 
after  the  escape  of  this,  all  the  disorders  disappeared  by  degrees,  and  con- 
valescence proceeded  rapidly.     Within  a  month,  all  M.  V 's  functions 

were  performed  with  a  regularity  which  he  had  not  enjoyed  for  twenty 
years  previously. 

M.  V possessed  considerable  natural  talents,  and  related  the  sensa- 
tions he  had  experienced,  the  opinions  he  had  formed  on  his  disease,  and 
the  motives  of  his  most  extraordinary  actions,  in  a  very  lively  manner. 

Two  months  afterwards,  however,  M.  V came  to  me  as  sad  as  ever. 

He  informed  me  that,  being  tormented  by  frequent  erections,  he  had  more 
consulted  his  desires  than  his  strength.  This  want  of  restraint  had  repro- 
duced in  a  fortnight  all  the  irritation  under  which  he  had  previously  suffered, 
with  the  disorders  following  it.  He  had  then  broken  off  these  habits,  but 
his  health  had  not  become  re-established  because  diurnal  spermatic  dis- 
charges had  reappeared. 

I  performed  a  second  cauterization  similar  to  the  first,  and  with  an  equally 

good  result ;  and  this  time  M.  V ,  having  gained  experience,  became 

more  moderate  in  his  conduct  and  returned  to  his  residence. 

This  case  ought  to  be  placed  by  the  side  of  the  first  two  I  have 
related  in  which  the  post-mortem  appearances  are  recorded.  The 
symptoms  were  almost  as  severe  ;  they  presented  the  same  characters, 
and  gave  rise  to  the  same  delusions  as  to  the  state  of  the  brain. 

The    rapid   re-establishraent  of  the   intellectual  functions  in  M. 

V proves  that  he  had  no  greater  cerebral  disorganization  than 

the  other  patients;  it  seems  probable,  however,  that  in  the  first 
cases  the  alterations  of  the  spermatic  organs  had  proceeded  further 
than  in  the  case  just  related. 

The  obstinacy  with  which  M.  V continued  to  treat  an  imagi- 
nary venereal  affection  is  remarkable ;  we  have  already  seen  an  in- 
stance of  it  in  the  fifth  case  I  have  recorded.  In  neither  case  were 
there  syphilitic  symptoms,  either  primary  or  secondary.  Such  pre- 
convictions are  very  common  in  nervous  patients,  and  their  surgeons 
sometimes  share  them.  The  wandering,  dull,  and  deep-seated  sen- 
sations complained  of  are  especially  liable  to  be  mistaken  for  the 
pain  in  the  osseous  system  which  follows  syphilis. 

This  case  is  well  suited  to  show  how  difficult  it  is  for  patients  to 
discover  those  seminal  discharges  which  take  place  whilst  emptying 

the  bladder  and  rectum.     M.  V had  only  one  wish — to  discover 

the  origin  of  his  disorder.  To  this  desire  he  sacrificed  every  con- 
sideration, and  for  this  end  he  came  to  Montpellier  to  study  medi- 
cine: he  was  not  far  from  the  truth,  for  he  thought  constantly  of 
the  blennorrhagia  which  had  preceded  the  disease,  yet  after  fifteen 
years  of  daily  observation  and  seven  years  of  application  to  medical 
studies  be  had  not  even  suspected  the  existence  of  involuntary  sper- 
matic discbarges. 


74  CAUSES    OF 

Let  us  judo-e  by  this  how  many  hypochondriacs  owe  their  torments 
to  the  same  cause. 


CASE  IX. 

Blennorrhaqia.,  foUoioed  hy  excoriations  of  the  qians  penis — Spermatorrhoea 
—  Cauterization  tmsuccessfid — Artificial  sulphur  baths — Cure. 

M.  B ,  Lieutenant  of  Light  Cavalry,  affected  with  varicocele,  con- 
tracted blennorrhagia  in  1818.  Emollient  drinks  and  warm  baths  reduced 
this  attack  at  the  end  of  a  month  to  a  slight  discharge,  which  soon  after 
entirely  ceased ;  excoriations  had,  however,  previously  appeared  around  the 
orifice  of  the  glans  penis.  These  excoriations  healed  in  about  twenty  days, 
under  the  use  of  cold  lotions :  they  reappeared  four  months  after,  and  were 
cured  by  the  same  means;  they  afterwards  showed  themselves  periodically 
every  three  or  four  months,  and  were  not  in  any  way  affected  by  anti-vene- 
real treatment  of  a  very  active  kind,  which  the  patient  submitted  to.  Each 
time  their  appearance  was  preceded  by  pain  in  the  perineum  and  testicles, 
increased  by  the  passage  of  feces. 

After  the  expiration  of  five  years,  the  excoriations  ceased,  and  the  pain, 
which  had  previously  been  relieved  by  their  appearance,  became  permanent, 
and  was  accompanied  by  discharge  of  semen  during  defecation.  The  pa- 
tient suffered  pain  in  the  region  of  the  kidneys,  which  became  insupport- 
able after  re-maining  under  arms  for  a  few  minutes ;  his  urine  deposited  a 
whitish  sediment. 

Sea  bathing  increased  the  pain  in  the  perineum,  and  the  difficulty  of 
passing  urine  :  fresh-water  bathing  increased  the  pain  in  the  loins :  his  di- 
gestion was  disordered. 

When  M.  B came  to  ask  my  advice,  I  at  first  suspected  that  a  stric- 
ture existed,  and  endeavored  several  times  to  examine  the  urethra  with  a 
soft  wax  bougie;  each  time,  however,  the  instrument  was  arrested  in  a  diffe- 
rent situation,  and  when  withdrawn,  presented  a  diffei'ent  form.  After  a  few 
days'  rest,  I  introduced  an  ordinary  catheter  into  the  bladder,  without 
meeting  with  any  permanent  obstruction,  but  with  severe  pain  to  the  pa- 
tient, especially  in  passing  the  bulb  of  the  urethra.  There  was,  then,  in 
this  patient,  only  a  state  of  extreme  irritability  of  the  urethral  mucous  mem- 
brane. I  hoped  to  cure  this  by  means  of  cauterization  with  the  nitrate  of 
silver,  as  I  had  done  before;  but,  on  this  occasion,  no  eBFect  was  produced. 

Recollecting,  then,  that  the  disappearance  of  the  excoriations  on  the  glans 
penis  had  been  followed  by  an  increase  of  the  disease,  I  prescribed  artificial 
sulphur  baths,  containing  two  ounces  of  sulphuret  of  potassium  in  each. 
At  first,  the  baths  produced  an  excellent  effect,  but  afterwards  a  severe  irri- 
tation of  the  stomach,  and  the  return  of  all  the  symptoms  were  occasioned. 
I  .discovered,  however,  that  sulphuric  acid  had  been  added  to  the  last  baths : 
this  was  omitted,  and  as  soon  as  the  patient  resumed  the  use  of  the  baths 
containing  sulphur  of  potassium  only,  his  state  improved  rapidly. 

At  the  expiration  of  a  month,  his  pain  had  disappeared,  his  urine  was 
transparent,  and  the  passage  of  feces  was  no  longer  accompanied  by  seminal 

discharge;  digestion  became  active,  and  M.  B soon  regained  his  strength 

and  stoutness. 


SPERMATORRH(EA.  75 

M.  B ,  previously  to  the  attack  of  blennorrhagia,  had  never 

sufiered  from  any  cutaneous  aftection  ;  from  this  date  ulceration  ap- 
peared periodically  round  the  glans  penis  :  this  might  be  supposed 
to  have  arisen  from  a  syphilitic  affection,  but  it  resisted  the  most  ac- 
tive anti-venereal  treatment.  Its  appearance  put  an  end  to  the  pain 
in  the  perineum  and  testicles:  as  soon  as  the  sores  healed,  these  symp- 
toms returned,  and  diurnal  spermatic  discharges  accompanied  them. 

It  seemed  probable  that  the  application  of  nitrate  of  silver  would 
lessen  the  morbid  irritability  of  the  urethral  mucous  membrane;  it 
produced  no  appreciable  effect,  however. 

Artificial  sulphur  baths  were  used  with  advantage  when  they  con- 
tained only  sulphuret  of  potassium  ;  when  sulphuric  acid  was  added, 
in  order  to  increase  their  activity,  all  the  symptoms  reappeared ;  on 
resuming  the  use  of  the  sulphuret  of  potassium  alone,  the  cure  pro- 
ceeded with  rapidity. 

It  is  remarkable,  also,  in  this  case,  that  river  bathing  always  in- 
creased the  pain  in  the  loins,  while  sea  bathing  aggravated  the  pain 
in  the  perineum.  Anomalies  of  this  kind  abound  in  the  treatment 
of  spermatorrhoea,  and  much  careful  research  is  often  necessary  to 
explain  them  ;  the  relation  of  such  cases  will,  however,  put  practi- 
tioners on  their  guard  by  furnishing  analogies  for  their  guidance. 

Baths  containing  sulphuret  of  potassium  are  especially  indicated 
whenever  a  cutaneous  affection  coexists  with  considerable  sensibility 
of  the  mucous  surfaces;  but,  when  the  irritation  of  the  genital  organs 
is  very  severe,  they  are  often  contraindicated.  In  such  cases  cauteri- 
zation, though  it  may  not  cure,  at  least  will  diminish  the  excessive 
sensibility.^ 

Causes. — I  have  before  stated  that  the  cause  of  spermatorrhoea 
is  a  most  important  circumstance  for  our  consideration.  The  truth 
of  this  becomes  more  evident  as  we  proceed  ;  but  it  often  happens 
that  several  causes  act  simultaneously  or  successively,  and  that  we 
are  not  able  clearly  to  discover  which  of  them  exercises  the  greatest 
influence  in  the  production  of  the  disease. 

Blennorrhagia  is  the  most  active  and  the  most  direct,  as  well  as 
the  most  easily  appreciated,  of  all  these  causes,  and  this  is  why  I 
have  commenced  by  reporting  cases  in  which  it  has  played  a  princi- 
pal part.  When  these  cases  are  examined  separately  with  some 
attention,  we  soon  perceive  that  the  discharge  has  been  preceded, 
accompanied,  or  followed,  by  some  circumstances  capable,  by  their 
own  action,  of  giving  rise  to  spermatorrhoea.  It  is  necessary  to  pay 
attention  to  this  point. 

In  one  patient  I  had  occasion  to  treat,  hereditary  predisposition 

'  M.  Lallemand  has  reported  many  more  cases  of  involuntary  spermatic  discharges 
following  blennorrhagia;  as,  however,  they  differ  very  slightly  from  one  another,  and 
the  same  treatment  was  applied  to  all,  I  have  thought  it  as  well  to  omit  the  remainder 
of  them.  In  fact,  the  connection  between  blennorrhagia  and  involuntary  spermatic 
discharges,  seems  so  well  established  by  the  cases  above  related,  as  to  require  no 
further  confirmation. — [H.  J.  McD.] 


76  CAUSES    OF 

probably  existed,  for  his  father  had  been  also  affected  by  spermator- 
rhoea; others  had  a  very  marked  lymphatic  temperament,  as  in  the 
fifth  case  I  have  reported.  Many  were  naturally  weak,  delicate,  and 
nervous ;  or  their  health  had  been  injured  by  bad  habits,  or  a  too 
sedentary  life;  others,  again,  suffered  from  tetters,  haemorrhoids,  or 
varicocele. 

By  far  the  greater  number  of  the  patients  who  have  come  under 
my  care,  had  committed  excesses,  either  in  coitus,  masturbation,  or 
the  use  of  alcoholic  stimulants. 

Blennorrhagia  in  many  cases  is  neglected ;  patients  are  too  timid 
to  mention  it,  or  too  careless,  and  too  much  occupied  to  pay  attention 
to  it;  in  other  cases,  the  treatment  is  rendered  useless  by  imprudence 
or  excess;  but,  in  many  cases  the  inflammation  produces  injurious 
effects  by  its  simple  presence  for  a  short  time. 

Many  of  my  patients  had  had  two  attacks  of  blennorrhagia,  and  in 
one  case  as  many  as  seven  were  experienced,  before  spermatorrhoea 
commenced;  but,  I  must  remark,  that  in  these  cases,  the  recurrence 
of  the  discharge  is  not  always  due  to  a  fresh  infection,  as  the  patients 
and  many  surgeons  believe  ;  the  facility  with  which  blennorrhagia 
often  recurs  without  coitus,  is  sufficient  evidence  that  it  may  return 
spontaneously,  or,  at  all  events,  from  very  slight  excitement.  This 
disposition  to  a  recurrence  of  the  discharge  may  be  easily  understood, 
if  the  increased  development  of  the  capillary  system  in  the  mucous 
follicles  after  repeated  or  continued  attacks  of  inflammation  be  taken 
into  consideration. 

,  These  patients  almost  always  in  the  end  suffer  from  spermator- 
rhoea. In  fact  it  is  difficult  to  avoid,  sooner  or  later,  an  extension 
of  the  inflammation  of  the  prostatic  mucous  follicles  to  the  spermatic 
ducts.  We  must  not,  however,  mistake  for  semen,  the  mucus  which 
constantly  moistens  the  urethral  orifice  in  such  persons ;  and,  on  the 
other  hand,  we  must  be  careful  to  guard  against  repelling  too  lightly 
their  apprehensions  on  this  account,  because  chronic  catarrh  of  the 
urethra  often  accompanies  spermatic  discharges;  and  is  a  sign  of  their 
presence  by  no  means  to  be  disregarded. 

In  some  of  the  cases  I  have  seen,  involuntary  spermatic  discharges 
seem  to  have  been  kept  up  by  venereal  taint,  and  such  have  been 
relieved  by  anti-venereal  treatment ;  on  the  other  hand,  in  some 
cases,  the  seminal  discharges  have  not  seemed  to  be  influenced  either 
by  the  venereal  affection,  or  the  means  employed  for  its  cure. 

Anti-venereal  treatment  is  frequently  also  employed  in  patients 
who  have  suffered  merely  from  blennorrhagia,  and  in  a  very  nume- 
rous class  of  cases  it  produces  a  serious  increase  of  the  irritation  in 
the  genital  organs,  and  causes  the  appearance,  or  exasperates  the 
effects,  of  involuntary  spermatic  discharges. 

Cases  of  this  nature  often  present  considerable  difficulties  of  diag- 
nosis ;  and  the  solution  of  these  obscurities  is  always  of  much  im- 
portance in  determining  the  treatment  to  be  followed. 

Anti-venereals  are  not  the  only  therapeutic  agents  which  produce 


SPERMATOERHCEA.  77 

such  unfortunate  effects  ;  those  which  <a  blind  routine  of  practice  em- 
ploys in  cases  of  blennorrhagia  have  not  been  less  injurious ;  among 
these  it  is  especially  necessary  for  me  to  mention  astringent  injections, 
copaiba,  cubebs,  tonics,  and  bitters  employed  too  soon,  or  in  extreme 
doses.  All  these  means  act  more  or  less  by  exciting  the  genito-uri- 
nary  organs ;  it  is  therefore  easy  to  understand  that  their  untimely 
or  immoderate  use  must  favor  an  extension  of  the  inflammation  from 
the  urethra  to  the  mucous  membranes  which  are  continuous  Avith  it. 

I  am  far,  however,  from  wishing  to  prescribe  the  use  of  these  re- 
medies, and  I  willingly  bear  testimony  to  their  beneficial  effects, 
after  the  inflammatory  symptoms  have  been  subdued.  A  time  ar- 
rives when  the-  mucous  membrane  of  the  urethra,  like  all  other 
membranes  of  the  same  class,  requires  the  employment  of  tonics 
and  astringents ;  but  in  the  way  they  are  daily  prescribed,  I  am 
convinced  more  harm  than  good  results  from  their  use. 

Lastly,  spermatorrhoea  is  often  made  worse  by  the  very  means 
employed  for  its  removal,  and  among  these  may  be  ranked  cold 
baths,  ice,  tonics,  bitters,  sulphur  baths,  &c. 

In  all  the  cases  I  have  so  far  considered,  blennorrhagia  has  exer- 
cised the  chief  influence  in  inducing  spermatorrhoea ;  it  is,  however, 
rarely  sufficient  singly  to  bring  on  this  fatal  disease,  and  the  causes, 
which  in  the  cases  I  have  related  have  been  accessory  only,  may  ex- 
cite, each  by  its  own  action,  more  or  less  serious  involuntary  seminal 
discharges.  These  accessory  causes  exercise  too  great  an  influence 
to  be  passed  over  in  silence  :  they  are  numerous  and  various,  and 
succeed  or  are  combined  with  one  another  in  different  ways — two 
cases  seldom  occurring  which  resemble  each  other  exactly. 

The  further  we  advance  the  more  plainly  we  shall  see  how  neces- 
sary it  is  for  the  different  forms  of  spermatorrhoea  to  be  described  as 
simple  affections — how  necessary  it  is  to  regard  them  in  all  their 
aspects,  and  to  take  account  of  all  the  circumstances  which  assist  in 
producing  them.  In  practice  we  find  it  indispensable  to  weigh  well 
all  the  points  connected  with  a  case  of  spermatorrhoea,  before  de- 
ciding on  our  diagnosis,  prognosis,  or,  especially,  on  our  treatment. 

Mode  of  Action. — In  all  the  cases  I  have  related  the  urethra 
retained  an  excessive  irritability,  especially  in  the  prostatic  region ; 
the  patients  felt  constant  pain,  weight,  heat,  darting  or  painful  tick- 
ling in  this  situation ;  and  these  sensations  were  increased  by  the 
passage  of  urine. 

Catheterism,  though  performed  carefully,  always  produced  acute 
pain  and  spasm,  sometimes  sufficiently  violent  to  simulate  stricture. 
The  catheter  was  especially  arrested  at  the  neck  of  the  bladder,  and 
often  it  could  only  be  passed  on  after  waiting  a  considerable  time. 
The.  patients  felt  as  if  the  instrument  had  passed  over  spots  of 
ulceration.  They  were  convulsively  agitated,  and  all  the  power  of  a 
determined  will  was  often  insufficient  to  restrain  their  expressions  of 
agony.  Their  faces  were  distorted,  and  their  whole  bodies  covered 
by  a  profuse  sweat.  As  soon  as  the  catheter  was  withdrawn,  a  con- 
siderable quantity  of  florid  blood  was,  in  most  cases,  discharged. 


T'g  CAUSES   OF 

These  different  phenomena,  which  occur  with  more  or  less  severity 
in  every  case,  sufficiently  indicate  that  the  mucous  membrane  of  the 
urethra  possesses  an  extreme  irritability,  especially  in  the  prostatic 
region.  Several  of  the  symptoms  are  even  sufficient  to  make  one 
suppose  that  it  is  granular,  and  very  vascular  or  excoriated.  A  few 
of  the  patients  I  have  treated  experienced  symptoms  indicating  still 
more  positively  an  affection  of  the  prostate,  such  as  swelling  of  the 
oro-an,  sense  of  weight  in  the  rectum  and  perineum,  darting  pains  in 
the  neck  of  the  bladder  behind  the  pubes,  &c.,  and,  in  one  case,  the 
inflammation  of  the  prostate  ended  in  suppuration.  In  many  cases 
the  testicles  were  swollen,  inflamed,  and  painful  (as  in  the  fifth  and 
ninth  cases).  The  spermatic  cords  also  shared  the  condition  of  the 
testicles,  as  in  these  cases.  Lastly,  in  some  patients  who  have  con- 
sulted me,  the  seminal  emissions  contained  blood  or  pus. 

Thus,  in  all  such  cases  the  blennorrhagia  leaves  great  irritation 
and  morbid  sensibility  in  the  urethral  mucous  membrane,  most  se- 
vere in  the  neighborhood  of  the  prostate,  the  principal  seat  of  the 
primary  disease.  In  many  cases  the  inflammation  extends  its  influ- 
ence to  the  testicles  by  means  of  their  excretory  ducts,  and  this 
should  make  us  suspect  that  the  spermatic  organs  may  retain  the 
same  irritability  as  the  urethra. 

The  same  phenomena  are  manifested  in  the  urinary  organs;  indeed, 
their  resemblance  to  the  spermatic  is  remarkable  in  more  respects 
than  one. 

Many  of  my  patients  had  experienced  acute  inflammation  of  the 
bladder  (as  in  the  seventh  case).  Others  had  suffered  from  symp- 
toms of  chronic  inflammation  of  that  organ.  In  a  few,  the  inflam- 
mation seemed  even  to  extend  to  the  kidneys,  if  we  may  judge  from 
the  pain,  spasm,  and  dragging  felt  in  the  loins,  and  the  changes  ob- 
served in  the  urine. 

These  are  the  only  circumstances  which  enable  us  to  appreciate 
the  state  of  the  kidneys — organs  out  of  reach  of  physical  examina- 
tion ;  but  analogy  confirms  the  results  deducible  from  them.  After 
having  unequivocally  proved  the  presence  of  orchitis,  under  similar 
circumstances  we  may  well  suspect  the  presence  of  nephritis,  espe- 
cially when  we  observe  symptoms  which  are  otherwise  inexplicable. 
Post-mortem  inspections  have  shown,  in  many  cases,  that  these 
analogies  do  not  deceive  us,  and  I  have  found  in  the  kidneys  varied 
and  serious  alterations  of  structure  which  could  only  have  been  pro- 
duced by  inflammation. 

All  such  patients,  without  exception,  pass  more  urine  during  the 
twenty-four  hours  than  natural :  so  that,  although  the  kidneys  may 
not  be  actually  inflamed,  it  is  evident  that  they  are  in  a  state  of  more 
or  less  active  irritation,  or,  at  least,  of  sufficient  excitement  consider- 
ably to  increase  their  action.  The  same  condition  obtains  in  the 
testicles,  for  although  they  may  not  be  the  seat  of  either  inflamma- 
tion or  pain,  their  activity  is  increased.  The  semen  is  not  only  ex- 
pelled involuntarily,  but  it  is  also  secreted  in  greater  abundance 


SPERMATORRHCEA.  79 

than  natural;  for  unless  the  secretion  were  increased  the  seminal 
emissions  would  not  be  so  frequent,  and  the  weakening  and  ex- 
haustion would  not  proceed  so  rapidly. 

The  urine  is  not  only  more  abundant  but  its  nature  is  also  changed, 
even  after  the  pus  and  mucus  contained  in  it  have  been  removed. 
It  is  paler  and  more  watery,  and  contains  less  urea  and  uric  acid 
than  natural. 

The  semen  also  loses  its  peculiar  odor,  its  color,  and  its  consist- 
ence;  it  is,  in  fact,  less  perfectly  formed  than  it  ought  to  be. 

Lastly,  all  these  patients  experience  a  frequent  desire  to  micturate, 
depending  on  the  irritation  of  the  bladder.  Some  are  unable  to  hold 
their  urine  more  than  half  an  hour  or  an  hour  (case  seventh).  In 
all,  the  desire  of  micturition,  comes  on  sudilenly  and  imperiously  ; 
the  spasmodic  contractions  of  the  bladder  overcome  all  the  efforts 
of  the  will,  and  the  emission  takes  place  suddenly  and  convulsively. 

This  phenomenon  gives  us  an  exact  view  of  what  passes  in  the 
vesiculse  seminales  during  involuntary  seminal  discharge;  some  pa- 
tients even  feel  distinctly  the  contractions  which  announce  an  emis- 
sion as  inevitable;  others  have  not  sufficient  practical  knowledge  to  re- 
cognize them,  but  their  statements  show  that  the  same  phenomena 
are  experienced,  even  when  analogy  would  not  lead  us  to  admit  their 
presence.  The  analogy  is,  however,  very  evident,  for  it  is  especially 
during  the  expulsion  of  the  last  drops  of  urine  that  the  spermatic  dis- 
charge takes  place,  and  the  two  classes  of  symptoms  are  in  general 
relieved  or  exasperated  at  the  same  time  and  by  the  influence  of  the 
same  causes.  This  remarkable  resemblance  may  be  explained  very 
simply  by  referring  to  the  fact,  that  blennorrhagia  has  its  principal 
seat  in  the  prostate,  Avhere  the  spermatic  and  urinary  apparatus 
meet,  and  the  connection  of  the  two  classes  of  phenomena  enables  us 
still  better  to  understand  the  causes  and  mechanism  of  spermatorrhoea. 

Treatment. — It  is  by  no  means  astonishing  that  in  this  state  the 
application  of  the  nitrate  of  silver  to  the  prostatic  mucous  membrane 
should  produce  effects  more  direct  and  powerful  than  those  of  any 
other  remedy.  We  know  well  how  promptly  and  effectually  nitrate 
of  silver  acts  on  tissues  which  are  granular,  injected  or  swollen  from 
the  effects  of  prolonged  inflammation.  Its  results  are  especially  evi- 
dent  in  the  chronic  ophthalmia  of  scrofulous  patients.  Soon  after 
the  nitrate  has  been  applied,  the  tissues  empty  .themselves,  contract 
and  become  paler,  and  they  retain  an  energetic  action  which  pre- 
serves them  from  a  relapse,  to  which  the  patients  are  often  liable 
when  a  cure  has  been  obtained  by  other  means.  On  this  account  I 
have  employed  nitrate  of  silver  in  the  chronic  inflammation  of  the 
vagina  and  neck  of  the  uterus,  which  keeps  up  leucorrhoeal  discharge 
in  so  many  cases,  and  in  chronic  catarrh  of  the  bladder,  which  is  so 
difficult  of  cure  by  other  means ;  and  I  have  always  had  cause  to  be 
pleased  with  its  action  in  these  affections.  The  nitrate  produces  the 
same  effects  on  the  mucous  membrane  of  the  prostatic  portion  of  the 
urethra ;  the  organization  and  sensibility  of  the  membrane  are  con- 


80  CAUSES    OF    SPEEMATOREHCEA. 

siderably  altered,  and  this  change  is  soon  felt  by  the  organs  which 
are  immediately  influenced  by  its  condition. 

Hitherto  relaxation  of  the  ejaculatory  ducts  have  been  alone  thought 
of  in  cases  of  spermatorrhoea,  and  this  exclusive  idea  has  been  a 
cause  of  much  malapraxis  ;  but  to  attribute  all  cases  of  spermatorrhoea 
to  irritation  of  the  spermatic  organs  only,  would  be  quite  as  erroneous 
and  injurious.  One  patient  I  had  occasion  to  treat  was  cured  by 
tonics,  another  by  antiphlogistics  (case  fifth) ;  and  I  shall  have  to  re- 
cord other  cases  of  the  same  nature,  but  they  are  very  rare.  There 
exist  almost  always  at  the  same  time  irritability  and  debility,  extreme 
sensibility,  and  loss  of  tone  in  the  spermatic  organs.  This  state, 
however,  we  observe  in  the  chronic  affections  of  all  mucous  mem- 
branes ;  indeed,  we  may  even  say,  as  a  general  rule,  that  the  weaker 
the  organs  or  individuals,  the  more  easily  are  they  excited. 

By  acting  on  the  surface  of  the  engorged  tissue,  its  morbid  sus- 
ceptibility is  changed,  and  a  contraction  is  afterwards  excited  in  it, 
which  gives  it  energy.  This  is  why  one  application  of  nitrate  of 
silver  generally  sufllices  to  produce  a  perfect  cure. 

But  when  the  disease  has  existed  a  long  time  the  genital  organs 
share  the  general  debility  of  the  system,  and  after  the  chronic  in- 
flammation has  disappeared,  it  becomes  necessary  to  aid  the  relaxed 
tissues  to  resume  their  former  energy  ;  nothing  now  contraindicates 
the  exhibition  of  tonics  of  'all  kinds,  which  complete  the  cure  com- 
menced by  cauterization.  This  explains  how  cold  and  sulphur  baths, 
ice,  &c.,  are  useful  after  cauterization  to  individuals  who  were  in- 
jured by  them  at  first  (case  ninth). 

Symptoms. — Whilst  examining  the  mode  of  action  of  blennorrhagia 
in  producing  spermatorrhoea,  I  have  already  referred  to  the  symp- 
toms which  occurred  in  the  cases  reported  ;  in  the  other  cases  1  have 
seen,  the  symptoms  have  been  common  to  all  kinds  of  spermatorrhoea, 
and  I  cannot  notice  them  here  without  being  exposed,  by  and  by,  to 
useless  repetitions.  I  shall,  therefore,  only  call  attention  at  present 
to  the  insidious  character  of  the  general  symptoms  produced  by  these 
discharges,  which  often  simulate  the  characteristic  marks  of  cerebral 
afi'ections,  gastritis,  diseases  of  the  heart,  urinary  calculus,  &c. 

The  real  cause  of  the  symptoms  is  very  difficult  of  detection  in 
cases  of  spermatorrhoea :  some  of  my  patients  had  studied  medicine 
for  many  years,  in  the  sole  hope  of  discovering  it  (case  eighth) ;  we 
may  judge  from  this  how  frequently  cases  of  spermatorrhoea  are  mis- 
taken for  other  afi'ections. 


(    81    ) 


CHAPTER  IV. 

CAUSES  OF  SPERMATORRHCEA. 

Cutaneous  Affections. 

The  follo^^■ing  case  is  that  of  a  student  of  medicine  who  came 
under  my  care.  At  my  request,  he  put  it  into  its  present  form  for 
publication. 

CASE  X. 

Itch  during  ten  months  at  about  the  age  of  fourteen — Pain  in  the  epigas- 
trium—  Tumor  of  the  testicle — Chronic  injiammation  of  the  bladder — 
Diurnal  spermatic  discharges — Jli/jwchondriasis — Cure  hy  Cauterization 
at  the  age  of  twenty-eight. 

"  Up  to  the  age  of  fourteen,  my  health  was  very  good,  but  at  this  period 
I  was  afflicted  with  psora,  which  continued  for  ten  months  in  spite  of  va- 
rious modes  of  treatment.  Scarcely  was  this  cured  than  I  felt  a  sharp  cut- 
ting pain  in  the  epigastrium,  after  a  time  becoming  dull  and  extended.  The 
itching  I  had  before  felt  over  the  whole  body  seemed  to  affect  my  head,  and 
when  I  had  been  exposed  to  cold  or  damp,  or  had  kept  my  head  uncovered, 
the  scalp  became  covered  with  little  pimples,  which,  when  scratched,  formed 
scabs. 

"  An  induration  of  the  left  testicle,  of  about  the  size  and  shape  of  a  bean, 
appeared,  and  continued  during  eight  months.  My  digestion  became  de- 
ranged ;  my  complexion  darkened,  and  my  shoulders  became  round ;  the 
epigastric  region  was  so  tender  that  I  could  not  bear  the  weight  of  the  bed- 
clothes, and  when  erect  I  seemed  to  have  a  weight  suspended  within  me. 
At  this  time  I  was  at  school,  but  during  the  vacation  I  took  an  opportunity 
of  consulting  my  family  surgeon;  he  attributed  all  I  felt  to  too  rapid  growth. 
Not  being  satisfied  with  this  explanation,  I  consulted  a  bone-setter  well 
known  in  the  neighborhood,  who  said  my  breast  bone  was  dislocated,  pre- 
tended to  replace  it,  applied  a  plaster,  and  sent  me  away  as  I  came. 

"  This  state  of  things  continued  till  I  was  eighteen,  when  I  experienced  a 
slight  pain  in  making  water,  and  became  very  costive.  The  epigastric  pain 
diminished,  however,  and  I  gained  flesh. 

"  At  the  age  of  twenty- two,  after  domestic  trouble,  and  perhaps,  also, 
from  the  effects  of  some  slight  excesses,  I  experienced  the  following  symp- 
toms :  Progressive  emaciation ;  lassitude  after  the  least  exertion ;  yellow, 
dry,  and  earthy  skin ;  burning  heat,  especially  in  the  palms  of  the  hands 
and  the  soles  of  the  feet;  creeping  sensations  over  all  the  body  when  I  began 
to  perspire;  habitual  sensation  of  internal  heat;  constant  pain  in  the  epi- 
gastrium and  right  hypochondrium ;  obstinate  constipation ;  difficult  diges- 
tion, attended  with -the  secretion  of  flatus;   acid  eructations,  smelling  of 


82  CAUSES    OF    SPEEMATOEKHCEA. 

putrid  eggs;  sometimes  cold  and  clammy  sweats,  especially  when  I  had 
taken  any  acrid  or  acid  substance,  or  when  I  experienced  the  slightest 
contradiction,  for  I  had  become  very  irritable ;  impossibility  of  enduring 
hunger ;  difficulty  of  holding  my  urine,  with  pain  at  the  base  of  the  glans 
penis,  and  spasm  at  the  neck  of  the  bladder  during  its  emission  ;  the 
urine  presenting,  when  cold,  a  red  muddy  appearance,  with  an  abundant 
brick-dust  sediment,  and  a  cloud  of  flocculent  matter  in  suspension ;  vene- 
real desires,  with  entire  loss  of  the  power  of  coitus ;  a  discharge  of  a  trans- 
parent and  viscid  matter  after  the  least  erection ;  an  abundant  discharge 
of  a  white,  serous,  slightly  opaque  matter  from  the  urethra  on  going  to 
stool;  scurf  and  itching  of  the  hea4 ;  noise  in  the  ears;  loss  of  memory; 
feeling  of  discontent  with  myself ;  extreme  timidity ;  dislike  to  all  amuse- 
ments save  solitary  walks;  deep  melancholy  without  cause  ;  loss  of  courage  ; 
sadness  of  countenance.  All  these  symptoms  were  aggravated  after  horse 
exercise. 

"  I  consulted  various  practitioners,  all  of  whom  considered  my  state  as 
nervous,  and  told  me  I  was  hypochondriacal ;  some,  however,  recommended 
emollients,  baths,  a  vegetable  and  milk  diet,  with  exercise  and  amusement; 
others  prescribed  bitters,  tonics,  alteratives,  preparations  of  sulphur  exter- 
nally and  internally,  an  issue,  &c.  All  these  modes  of  treatment  were  use- 
less, or  rather  they  increased  my  disorders,  and  in  my  painful  condition  I 
tried  to  contract  a  new  itch,  without  success. 

"I  now,  at  the  age  of  twenty  eight,  came  to  consult  you The 

introduction  of  a  catheter  gave  me  violent  pain,  and  caused  spasm  of  the 
urethra,  especially  near  the  bladder.  The  application  of  the  nitrate  of  silver 
dispersed  the  chronic  inflammation  which  kept  up  the  involuntary  discharge 
of  semen,  and  eight  days  after  the  cauterization  I  felt  stronger,  my  limbs 
seemed  more  free,  my  urine  became  clear,  and  I  began  to  hold  it  longer ; 
my  countenance  appeared  gay,  and  my  complexion  became  fair.  I  had  a 
nocturnal  emission,  a  thing  I  had  not  experienced  for  a  long  time.  At  the 
expiration  of  three  weeks  I  found  myself  in  a  perfectly  new  state ;  during  a 
period  of  ten  years  I  had  never  felt  so  well.  The  cerebral  functions,  and 
those  of  the  stomach,  intestines,  bladder,  and  genital  organs,  were  performed 
with  an  unaccustomed  energy ;  my  skin  had  lost  its  yellow  and  earthy 
appearance.  The  internal  burning  and  the  cutaneous  tingling  were  removed. 
Nocturnal  emissions,  however,  have  since  become  very  frequent,  and  from 
the  fourth  to  this  day,  the  twelfth  of  July,  I  have  had  four ;  nevertheless, 
my  strength  has  continued  to  increase  daily,  and  I  hope  that  a  second 
cauterization  will  remove  altogether  a  disease  which  all  previous  treatment 
had  only  served  to  increase." 

I  cannot  now  say  whether  I  yielded  to  this  patient's  desire  for  a 
second  application  of  the  nitrate  of  silver,  but  I  certainly  did  not 
share  his  uneasiness  respecting  the  nocturnal  emissions.  When  these 
Jollow  involuntary  diurnal  discharges  of  semen,  they  show  a  considera- 
ble improvement  in  the  state  of  the  genital  organs  ;  they  prove,  in 
fact,  that  the  semen  is  no  longer  expelled  as  before  in  an  almost  con- 
tinuous manner.  Indeed  the  patient  experienced  from  this  moment 
a  rapid  amelioration  in  all  his  functions,  and  an  increase  of  strength 
which  would  be  inexplicable  under  other  circumstances.  The  desire 
for  a  fresh  cauterization  was  not  alone  due  to  the  fear  of  nocturnal 


CUTANEOUS    AFFECTIONS.  83 

emissions ;  it  arose  partly  from  a  kind  of  blind  faith  in  a  remedy 
"which  had  produced  such  prompt  and  satisfactory  results. 

The  desire  for  a  second  application  of  the  nitrate  of  silver  is  felt 
by  many  of  the  patients  who  have  once  experienced  its  effects,  and 
I  have  often  been  obliged  to  resist  it.  We  must  only  return  to  this 
remedy  when  much  remains  to  he  effected^  and  when  all  improvement 
has  been  arrested  for  some  time  ;  so  long  as  progress  is  made,  how- 
ever slow  it  may  be,  there  is  reason  for  hoping  that  regimen,  exer- 
cise, and  a  moderate  use  of  the  organs,  ^ill  be  sufficient  to  confirm 
the  convalescence. 

The  rapid  cure  of  the  hypochondriasis,  treated  for  so  long  a  time, 
and  with  such  little  success,  by  so  many  different  means,  sufficiently 
testifies  that  it  originated  in  the  involuntary  loss  of  semen.  But  to 
what  cause  can  we  attribute  the  spermatorrhoea?  After  the  disap- 
pearance of  the  cutaneous  affection,  symptoms  of  chronic  inflammation 
of  the  stomach,  and  afterwards  of  the  bladder,  appeared.  Then  a 
tumor  arose  in  the  left  testicle.  The  connection  between  irritation 
of  the  skin  and  that  of  the  mucous  membranes  is  well  known,  and 
I  have  shown  the  manner  in  which  affections  of  the  urethra  extend 
to  the  testicles.  It  is  then  easy  to  understand  the  course  by  which 
irritation  extended  to  the  spermatic  organs,  and  excited  spasmodic 
contractions  of  the  seminal  vesicles. 

The  pain  which  the  patient  experienced  in  the  neck  of  the  bladder 
proves,  also,  that  the  involuntary  discharge  was  really  kept  up  by 
chronic  inflammation  in  that  situation ;  the  frequent  desire  of  mictu- 
rition and  the  state  of  the  urine,  together  with  the  sensations  produced 
by  catheterism,  and  especially  the  rapid  cure  effected  by  the  nitrate 
of  silver,  are  further  evidences  in  support  of  this  opinion. 

CASE  XI. 

Cutaneous  affections — Repeated  attacks  of  urethritis — Application  of  nitrate 

of  silvei —  Cure. 

M.  N ,  of  an  irritable  constitution  and  subject  to  frequent  and  varied 

cutaneous  eruptions  from  bis  infancy,  suffered  during  youth  from  several 
slight  attacks  of  urethritis,  which  always  passed  off  rapidly;  at  the  age  of 
twenty-one  he  married.  Still,  however,  the  discharges  reappeared  several 
times  with  various  degrees  of  duration  and  intensity,  alternating  sometimes 
with  tetters  and  at  others  with  boils.  The  urethritis  supervened  once  on 
an  eruption  of  pimples  on  the  head  which  had  lasted  very  long  and  left 
cicatrices  similar  to  those  of  smallpox.  At  other  times  unyielding  attacks 
of  ophthalmia  and  violent  rheumatic  pains  came  on  during  the  absence  of 
the  cutaneous  affection.  Several  times  slight  excoriations  became  irritated 
in  a  remarkable  manner,  and  a  simple  scratch  on  the  leg  kept  the  patient 
in  bed  for  several  months.  In  1820,  on  an  attack  of  numerous  and  large 
furuncles,  a  more  intense  and  painful  urethritis  than  usual  supervened.     I 

found  M.  N in  an  extreme  state  of  prostration  and  agitation,  excited  by 

harassing  suspicions  as  to  the  nature  of  this  discharge,  which  was  abundant 


84  CAUSES    OF   SPEKMATOREH(EA. 

and  greenish,  and  resembled  in  all  respects  that  of  an  intense  blennorrhagia. 
As  I  knew  my  patient's  constitution,  I  thought  that  the  discharge  depended 
on  the  general  cause  which  had  excited  the  former  attacks,  and  therefore 
prescribed  antiphlogistics  and  derivatives,  to  which  it  yielded. 

I  afterwards  advised  emollients  and  alterative  drinks,  and  still  later  the 

use  of  the  warm  sulphuretted  springs  :  M.  N went  successively  to  Cau- 

terets,  Luchon,  and  Aries,  near  Perpignan. 

At  the  expiration  of  three  years  his  general  health  was  improved,  but  the 
attacks  of  urethritis  reappeared  from  time  to  time,  especially  in  winter, 
when  irritation  no  longer  existed  in  the  skin  or  any  other  organ;  and  he  de- 
sired much  to  rid  himself  of  these  periodic  discharges  which  embittered  his 
existence.  I  had  previously  successfully  used  the  nitrate  of  silver  in  sub- 
stance in  several  cases  of  inveterate  blennorrhagia,  and  I  proposed  its  use  to 
him  with  the  hope  of  considerably  modifying  the  action  of  the  urethral 
mucous  surface.  He  submitted  to  it  with  eagerness,  and  the  results  sur- 
passed my  most  sanguine  expectations. 

Twelve  years  afterwards,  M.  N had  not  perceived  the  least  trace  of 

his  distressing  discharges,  although  he  had  travelled  much,  and  had  not 
restricted  himself  to  any  regimen  or  privation.  But  he  soon  perceived  much 
more  important  changes.  His  venereal  desires  became  more  active  and 
more  imperious,  his  erections  took  on  a  new  energy,  and  ejaculation  no 
longer  took  place  so  precipitately  as  before;  in  fact,  he  fouud  himself  at 
the  age  of  fifty-jfive  more  vigorous,  in  all  respects,  than  he  had  been  at 
twenty. 

This  single  cauterization  produced,  then,  a  perfect  revolution  in 

the  state  of  M.  N 's  genital  organs,  and  its  effects  remained  even 

after  the  expiration  of  twelve  years. 

To  obtain  a  correct  idea  of  the  importance  of  the  change  which 
had  taken  place  in  the  urethral  raucous  membrane  it  is  necessary  to 

remark,  that   M.   N remained    subject   to  the   same   cutaneous 

eruptions,  and  that  they  alternated  as  before  with  ophthalmia,  at- 
tacks of  gout,  wandering  pains  in  the  breast,  abdomen,  &c.,  but  that 
from  this  time  the  urethra  was  never  the  seat  of  the  inflammation, 
which  still  continued  to  attack  the  other  organs.  Thus,  although 
the  first  cause  continued  to  act  on  the  other  organs,  the  part  cau- 
terized remained,  after  twelve  years,  free  from  its  influence. 

On  the  other  hand,  if  we  may  be  allowed  to  judge  by  analogy  with 
the  preceding  cases,  and  by  the  general  symptoms  which  accompa- 
nied the  repeated  attacks  of  urethritis,  they  must  have  produced 
spermatorrhoea,  although  the  patient  himself  did  not  suspect  it.  This 
is  the  only  way  in  which  we  can  explain  the  increase  of  energy  in 
the  genital  organs  notwithstanding  the  effects  of  age,  and  the  in- 
creased vigor  of  the  whole  economy  in  spite  of  more  frequent  sexual 
intercourse. 

In  fact,  then,  the  nitrate  of  silver  not  only  put  an  end  to  the  dis- 
position to  urethritis,  but  also  destroyed  a  powerful  and  continually 
debilitating  discharge,  which  was  undermining  the  patient's  consti- 
tution, without  his  being  able  to  discover  the  cause  of  his  weakness. 


CUTANEOUS    AFFECTIONS.  85 


CASE  XIL 


Pniri(/iiioiis  emption  around  the  genital  organs — Two  attarJcs  of  hlennor- 
rhagia — Nocturnal  and  diurnal  emissions — Cure  hy  means  of  stdphu- 
retted  baths. 

M.  L ,  at  the  beginning  of  the  year  1824,  was  attacked  by  a  prurigi- 

nous  eruption  on  the  scrotum,  which  extended  rapidly  and  covered  the 
genital  organs.  After  the  least  irregularity  of  diet,  the  surface  of  the 
scrotum  assumed  an  inflamed  appearance,  and  secreted  a  fetid  discharge 
accompanied  with  violent  itching.  Baths,  lotions  of  milk,  decoctions  of 
various  kinds,  and  sulphur  ointment,  only  gave  temporary  relief. 

In  the  month  of  June,  1824,  four  months  after  the  first  appearance  of 

the  eruption,  M.  L contracted  a  urethral  discharge ;  the  inflammation 

accompanying  this  was  very  slight,  and  the  patient  subdued  it  by  baths  and 
emollients.  He  attempted  to  take  balsam  of  copaiba,  but  was  soon  obliged 
to  leave  off  its  use  on  account  of  the  irritation  it  produced  in  the  digestive 
organs.  The  urethral  discharge  diminished  rapidly,  but  did  not  entirely 
disappear,  a  slight  oozing  of  a  viscid  pearly  matter  remaining,  which  formed, 
at  the  orifice  of  the  glans,  a  little  crust  which  the  patient  was  obliged  to 
remove  in  order  to  give  passage  to  his  urine.  This  discharge  he  neglected, 
and  shortly  after  he  noticed  that  semen  was  passed  in  large  quantity  during 
defecation.  In  the  month  of  January,  1825,  he  contracted  a  second  ure- 
thritis, which  was  more  severe  than  the  first.  Acute  pain  was  present  in 
the  fossa  navicularis,  and  after  a  time  in  the  region  of  the  prostate.  In  a 
few  days  the  inflammation  was  accompanied  by  general  fever.  The  patient 
was  then  submitted  to  a  rigid  antiphlogistic  treatment,  and  at  the  expiration 
of  a  week  the  local  and  general  symptoms  were  much  relieved;  shortly 
after  the  discharge  ceased  entirely. 

In  the  month  of  February,  M.  L rubbed  in  mercurial  ointment  in 

order  to  prevent  a  venereal  contagion.  This  inunction  entirely  removed 
the  cutaneous  disease  of  the  scrotum,  but  a  few  days  afterwards  the  old 
discharge  reappeared,  accompanied  with  itching  of  the  anus,  and  contrac- 
tion of  the  sphincter  ani ;  feeling  of  arterial  pulsation  in  the  lower  part  of 
the  rectum,  especially  after  meals,  when  sitting,  or  during  defecation  ;  ob- 
stinate constipation;  urine  depositing  a  quantity  of  whitish  flocculi,  which 
formed  on  cooling  an  abundant  cloud  suspended  in  the  middle  of  the  fluid ; 
constant  oozing  of  a  fluid  resembling  semen,  which  formed  a  crust  at  the 
orifice  of  the  urethra ;  abundant  seminal  emissions  during  defecation ;  noc- 
turnal emissions  accompanied  by  pain  of  short  duration,  but  suQiciently 
acute  to  arouse  the  patient  from  a  deep  sleep;  extreme  sensibility  of  the 
canal  on  the  introduction  of  a  catheter,  with  acute  pain  in  the  prostatic  re- 
gion ;  the  retina  very  sensitive  to  the  effects  of  light ;  noise  in  the  right 
ear,  worse  at  night  than  in  the  morning,  and  difficult  digestion  accompanied 
by  abundant  discharge  of  flatus 

I  ordered  for  this  patient  twenty-four  sulphuretted  baths  containing  at 
first  one  ounce,  then  one  ounce  and  a  half,  and  afterwards  two  ounces  of 
sulphuret  of  potassium.  These  means  alone  sufficed  to  perform  a  perfect 
cure  at  the  expiration  of  two  months. 

It  is  impossible  that  both  attacks  of  blennorrhagia  in  this  patient  were 
contracted  in  the  ordinary  manner,  by  contact  with  blennorrhagic 
6 


80  CAUHKH    OK    HI'KTlTMATOUTlTTfKA. 

virus;  but  at  tlio  sarno  tiTrn;  tluH  dooH  not,  H(!(!rn  j)r()]))iJ)lc,  Ijochuho  tlio 
snpprcHsion  of  the  Hkin  (liHcaHO  on  tho  Hcrotuin  waH  roll()W(;<l  by  n,  re- 
turn of  tlio  (liBcliargc.  Tho  mucous  inctnhranos,  too,  Hccm  to  li!iv(! 
poHHCHSf'd  an  extraordinary  scnHibility,  8inco  tho  balsam  of  cojxiiba, 
^ivori  in  tlio  usual  doso,  induccMl  fj:^ron.t  irritability  of  tbn  dif.f(!Htivn 
ori!;iiiiH  after  a  few  days'  adrninistriition.  Tt  is  rcMnarlciible,  too,  tliat 
tbe  (les.Hiition  of  tlio  (lisoliar/^o  fol|{)vv(!d  tho  omission  of  tli(!  r(!niedy. 
This  HUS(;(!f)tii»ilit-y  of  tho  inuoous  membranc^s  is  very  common  in  oii- 
tatieous  afi'ections,  and  exjilains  tho  fre({U(!ney  of  non-contagious  at- 
tacks of  urethritis  in  patients  who  suflor  from  them. 

'I'he  disappearance  of  the  disease  in  the  skin  of  the  scrotum  was 
follow(Ml  by  tho  return  of  tho  nocturnal  arid  diurnal  fioilutions,  but 
this  time  the  irritation  was  more;  sov(!ro  than  ev(!r,  and  was  not  con- 
fined to  the  mucous  membraiu!  of  the  g(!nito-uriiiary  organs  ;  it  ex- 
tended also  to  that  of  the  rectum,  and  tho  patient  oxporionced  itch- 
ing of  tho  anus,  S[)a8m  of  tho  Sfihinctor,  and  a  fooling  of  pulsation 
in  the  lower  part  of  tho  intestine. 

This  coiiicidcMice  cori(lrm(;d  mo  still  more  firinly  in  the  opinion  that 
tho  previous  urethral  discharge!  had  not  been  owing  to  blcnuoriliagic 
contagion,  and  Icfl  mo  to  onbir  Bul[)hur(!tt(Ml  baths  ;  cautcn'i/.alion  of 
tho  urethra  would  have  jiroducod  no  (dl'cct  on  tho  irritation  of  tho 
rectum,  and  tho  latter  would,  alone,  probably  have  sudiccd  to  repro- 
duce involuntary  spermatic  discharges.  Tho  patient's  rapid  and 
perfect  cure  shows  that  tho  indication   followed  was   tho  correct  one. 

(!ASK  xiir. 

I/rrpcK  prnji'iiti(r/in  (i/f(rni(tfhi(/  in  <i  rcnuir/idhlr.  manner  vulli,  lriit<il!iin.  In. 
l/u:  prtmliUic  portion  of  tlir.  nrct/mi — Nnclnrndl  and  aflrrwunh  (tiurnal 
poll  III  ioHH —  (JiniHioniil  inipofnm — lin-cK/iihliithnicnt  lij/  id  iiliri:'.ntioii — 
RcUi'pm — Cur  I'.  Ill/  Ihi:  hittlm  of  Vcrnct. 

M.    15 ,  a  inngiHtrat(!,   of   ii,  iyinpliatieo-Kanguirio    tornp(!nmi<iil,   Imd 

ocofiHidiiully  prttctiHod  iiiiiHturliatidii,  hut  hud  never  eoiiiinil.ted  any  vetn^reai 
cxcesHOHS.  Ho  was  uttaekcd,  for  llw  fir.st  tiriu!,  at  the  a/^e  of  m\i}\U'vm,  with 
an  eruption  on  the  prcpinu!  wliicli  diKa[)peanw|  sp(>ntan(!OUHly,  reliiriKMl  hooii 
al't.(!r,  and  again  (liHapi)(ian!<l.  TIiiH  (truption  waH  (!all(!d  by  his  ni(!ili(!al 
attendant  lierp(!H  prie])utialiM.  I^'roiii  that  time  it  continued  to  return  at 
poriodH  of  ineniaHing  duration,  and,  at  various  tinioH,  presented  (;in;uiii- 
.stan(;(!S  worthy  of  notic.(!.  'riio  (!riJ[)tioiis  geiKirally  a[)ii(!anid  on  dill'crent 
Kpots,  to  tli(!  miiiiber  of  live  or  six,  and  w(!r(!  not,  at  lirnt,  larg(!r  tlian  a.  pin's 
liCiad,  but  were  aceotnpani(!d  by  violent  itching;  by  degnuis  the  HjiotH  in- 
ereascd  in  size  and  becmiiK!  unitcid,  after  whi(!li  they  were  dried  up,  leaving  only 
a  degree  of  nidiuiHS  wliitdi  soon  pasHed  off.  Tho  appcMiranco  of  these  (jrup- 
tioiiH  waH  always  pnifieded,  during  three  or  four  <iayH,  by  a  seiiHation  of 
lassitude,  and  of  weij!;ht  at  the  root  of  the  penis.  J)uring  the  eruption  the 
lassitude  left  the  paticitit  entindy,  and  (lie  sexual  itnpulse  and  pow(!r  were 
much  greater  than  usual.  The  njtuni  of  the  eruption  took  plaee,  at  first, 
every  two  or  thnio  inontlis,  then  (svery  year,  and  aftfir  that  every  two 
years;  and  when  M.  jJ consulted  inc  it  had  not  appeared  for  three 


I'UTANEOUvS    AFFECTIONS.  87 

yo!U's.  As  the  oruptioii  Mpi^t'annl  nicri*  nircly  i(  losi,  nlso,  iiuirli  of  its  duni- 
tidii  niul  iiitiMisity.      It  alway.s  yi''l<l«*tJ  '"  li^lions  of  I'old  walor. 

'l\\o  yonrs  ixUi'v  tlio  liist.  nppoiiranoo  of  tho  oruplioii,  1\1,  I> IkkI  nu 

iilt'oratitin  on  tho  penis.  'I'Ms  wiis  n'ijivriliHl  n.s  sypliilitio.  Still  Inh'r  lio 
liiul  two  attnoks  ot'  mi'lliml  dischar^o,  al'ltM*  wliioli  a.  swollinu;  at.  tho  anus 
supcrvoiiiHl.  All  (hi'so  syinptoius  woro  attacked  hy  a  rii^id  and  loiij.!;  eon- 
tiimed  anti-vonoioal   lrt>atuuMit., 

I>iirinM;  fho  twclvo   years  that  IM.  11 has  boon  married,  he  has  very 

rarely  had  sexual  inteteourso,  but  he  has  j^eiiendly  t>xpeiieMe(>d  three  or  I'lmr 
noeturnal  pollutions  in  the  lumrse  of  a.  mouth. 

l'\>r  the  last  lour  years  he  I\as  felt.  j);reater  sense  of  \vei;!;hl,  at  tlu*  root, 
oflhepeuis;  t>p()iil(tiii'()iiii  ereelious  have  disapjieartMl ;  those  whieh  he  has 
been  able  to  exeito  have  been  very  rare,  and  seldom  peri'eet.,  Mjaeulation 
has  always  been  hurried,  and  stunetimes  oven  has  jtreeeded  intromission. 
Iti  has  never  boon  aeeoutpanied  with  aout.o  sensation,  lutereourso  has  been 
followed  by  sloeplossnoss,  jfojieral  ])rostration,  irritation  and  spasms  in  tho 
stomaeh,  espoeially  if  it  has  taken  plaoo  in  the  oveniuj^.  Noeturnal  pollu- 
tions have  boon  very  abundant,  have  ooe\u*red  ahuost  without  ereetiou,  and 
havo  been  fidlowoil  by  mueh  more  serio\is  symptoms  than  (Muissions  foUow- 
\u^    eoifus.      b'or    tho    last   two    yi*ars,   neeturnal    emissions    havo    biuiouto 

i;r;idMally  n\oro   rari>,  and   M.  U has   notieed,    aeeidentally,    on    sovi'ral 

oee.'isiuns,  that  he  has  jiassod  semen  whilst  at  stotd,  allhou;i;h  his  bowels 

have  not  been  oimstipafed.     On  his  arrival  at   Montpollier  M.  \i was 

forty- two  years  of  a>:;e  ;  his  faeo  was  red,  and  he  appeared  in  ji;ood  hoaltli. 
Mut  his  digestion  was  badly  performed  ;  his  sleep  was  disturbed  ;  and  ht»  felt 
his  memory  and  int(>lloet  nuudi  we.dvoned.  The  proi<;re,ssivt^  loss  of  power 
ill  the  ;j;enital  or<>;ans  was  n  souree  o['  mueh  r(<j>;ret  to  him,  His  urine  was 
thick  and  very  fetid;   it  eontained  a   lar;:;e  quantity  of  mucous  llocculi,  and 

deposited  a  .sediment  of  matter  resomblinj^  semen.      IM.  H told  me  this 

appe.'iranee  had  been  present  in  itdurinii;  twelve  years.  Thus  the  alteration 
ill  his  urine  dated  from  about  the  lime  t)f  his  marriaj<;o. 

On  tho  sixth  of  May,  1S!U»,  I  eauteri/.od  the  urethra  from  the  nock  of 
the  bladder  as  far  as  tho  nienibranous  ptu'tion  ;  tho  olVeot  of  the  oporatiiuj 
was  }irompt  and  vory  evident.  Sixteen  d.ays  afterwards  tho  urine  was 
perfectly  transparent,  and  tho  i!;(>noral  stato  very  salisfaetory.  Il(^  w.as  then 
eompolleil  to    leave   Monlpeiru'r  sudd(>nly.     Three    months    afterwards    iM. 

H inf(UMned  mo  that  in  spite  of  the   irritation  e!i\i,S(>d  by  travelliiii!;,  his 

uriiK*  iuid  eoutinuod  trans|)arent,  and  that    his   genital   orjj^ans   had  acipiired 

an  iMiacousloiuod  (Miorjry.      In  fait  M.  H found  himself  so  well  that  ho 

oonsidured  it  nnnecess.iry  to  u.^e  the  niiiioral  w.'itcrs  as  1  had  rceommciided 
liim. 

Two  years  afterwards  IM.  H had  a  sli;j;ht  rel.'ipse,  which  yielded  r.'ipidly 

to  tiie  use  of  the  sulphuretted  waters  of  W'ruel,  near  l\>rpij:;uan. 

1  shall  ni>t  iiKiuire,  lierc,  wliellier  ihorc  was  r(*a.lly  l)ItMinorrhM,>j;io 
»'ontiij;i(m  ill  this  caso.  I  shall  only  roiniirk  tliiil;  tho  horpos  ap- 
peared a  louii;  time  bofore  any  sexual  inttu'eourso  ha.d  tukon  plaoo, 
and  that  its  ret  urn  was  aoeonipatiiod  by  vioKnit  pruritus,  and  in- 
ereaso  of  .'^exual  inipnlso ;  interoourso  would  in  0i)nstMjueiuH>  tiiko 
})liu'o  uioro  fretjuontly  dnrine;  iho  presonco  of  tho  eruption. 

The  singular  fonnoetion  of  tho  skin  nlVi'ction,  intorniittont  with 
attacks  of  blennorrluijjiii,  is  worthy  of  notico  ;   it  shows  a  continual 


88  CAUSES    OF    SPEKMATOEEHiEA. 

metastasis  of  the  irritation  of  the  prepuce  of  the  mucous  membrane 
lining  the  prostate.  As  soon,  therefore,  as  the  eruption  appeared, 
the  habitual  sense  of  weight  in  the  prostatic  region  was  relieved,  and 
the  activity  of  the  genital  organs  increased  ;  the  symptoms  connected 
with  the  prostate  reappeared  when  the  herpes  was  cured.  As  the 
eruption  diminished  in  frequency  and  intensity,  and  the  intervals 
between  its  appearance  became  longer,  the  functions  of  the  genital 
oro-ans  diminished,  and  at  length,  when  the  herpes  had  not  come  on 
for  some  time,  the  patient's  impotence  was  complete.  The  urine 
was  muddy  from  the  period  of  the  patient's  marriage  :  it  seems  pro- 
bable, therefore,  that  the  greater  frequency  of  sexual  intercourse 
contributed  to  the  production  of  diurnal  pollutions.  It  is  also  worthy 
of  notice,  that  as  the  nocturnal  pollutions  become  rarer,  the  debility 
of  the  genital  organs  was  shown  in  a  more  striking  manner,  and 
that  from  this  period  the  seminal  discharges  during  defecation  were 

sufficiently  abundant  to  be  remarked  by  the  patient.     M.  B 's 

impotence  was  not  absolute,  because  the  involuntary  discharges  va- 
ried much  in  amount.  This  variation  in  the  symptoms  is  a  charac- 
teristic feature  of  slight  cases  of  spermatorrhoea,  and  very  probably 
explains  the  uncertainty  of  temper  in  such  patients.  In  the  case  I 
have  just  reported  it  is  not  to  be  wondered  at,  when  the  intermissions 
of  the  cutaneous  affection  are  taken  into  account. 

Another  very  remarkable  case  in  which  blennorrhagia  occurred 
several  times  as  a  consequence  of  the  metastasis  of  cutaneous  affec- 
tions, will  be  found  in  my  10th  chapter. 

CASE  XIV. 

Lymphatic  temperamenl — Various  cutaneous  eruptions  alternating  with  other 
affections — Habitual  had  health — Hypochondriasis — Spermatorrhoea  un- 
discovered during  twenty-five  years — Cure  hy  sulphuretted  baths, 

M.  D ,  of  very  lymphatic  temperament,  was  subject,  in  bis  childhood, 

to  chilblains  and  a  cutaneous  affection  of  the  scalp  j  he  had  also  many  stru- 
mous abscesses  in  his  neck.  About  puberty  his  health  became  better,  but 
he  was  still  subject  to  attacks  of  ophthalmia,  discharge  from  the  ears,  and 
frequent  cutaneous  eruptions  of  different  kinds,  which  were  very  difficult  of 
cure,  and  alternated  with  sore  throat  or  chronic  affections  of  the  different 
mucous  membranes.  He  married  at  the  age  of  twenty-one,  and  never  com- 
mitted excesses  of  any  kind.     He  has  had  several  children. 

About  the  age  of  thirty,  tetters  appeared  on  his  face,  neck,  arms,  legs, 
scrotum,  and  perineum ;  these  were  sometimes  dry  and  squamous,  and 
changed  their  situation  very  rapidly.  They  were  often  followed  by  little 
pimples  which  appeared  in  different  parts  of  the  body,  causing  great  itching; 
at  other  times  boils  followed  them  and  lasted  for  months.  M.  D un- 
derwent various  modes  of  treatment  in  order  to  rid  himself  of  these  unplea- 
sant eruptions,  but  without  success — some  of  the  remedies  even  increasing 
his  disease. 

By  degrees  his  health  became  disordered  in  a  more  serious  manner;  he 
experienced  successively  symptoms  of  pulmonary  catarrh,  of  gastro-ente- 


CUTANEOUS    AFFECTIONS.  89 

ritis,  and  of  chronic  cystitis ;  he  was  also  subject  to  frequent  attacks  of 
rheumatism,  and  was  annoyed  by  obstinate  constipation  alternating  with 
diarrhoea.  His  digestion  by  degrees  became  diificult,  and  he  was  often 
attacked  with  flatulent  colic;  bis  bowels  were,  indeed,  always  distended  by 
flatus,  of  which  he  was  obliged  frequently  to  relieve  himself.  When  attacks 
of  colic  came  on  he  seemed  on  the  point  of  being  suffocated ;  blood  rushed  to 
his  head ;  his  face  became  purple ;  but  at  length  all  passed  off'  on  the  dis- 
charge of  immense  quantities  of  flatus,  which  often  continued  to  escape  for 
several  hours. 

From  this  time  he  ceased  to  go  into  society,  and  saw  only  his  most  intimate 
friends,  and  by  degrees  he  became  nervous  and  hypochondriacal.  An  excel- 
lent man  naturally,  he  now  was  ill  tempered,  peevish,  and  capricious,  and 
he  showed  great  weakness  of  character  and  morbid  sensibility.  A  slightly 
interesting  tale,  or  the  recital  of  an  instance  of  courage  or  devotion  affected 
him  to  a  foolish  degree,  and  he  was  particularly  alive  to  anything  he  con- 
sidered an  injustice. 

His  face  was  often  congested,  and  he  complained  of  stunning  sensations,  for 
the  relief  of  which  leeches  were  applied  to  the  anus,  and  he  used  foot-baths 
and  other  remedies  without  benefit.  At  length  his  legs  failed,  and  he  was 
obliged  to  give  up  the  frequent  walks  he  had  previously  taken. 

These  symptoms  were  looked  on  as  the  forerunners  of  apoplexy.  Leeches 
were  again  recommended  to  be  applied  to  the  anus,  but  the  patient  refused, 
because  he  had  never  been  benefited  by  their  application. 

Under  these  circumstances  I  was  consulted,  M.  D being  then  fifty- 
six  years  of  age.  I  was  for  several  days  unable  to  discover  the  cause  of  these 
various  symptoms,  so  long  and  complicated  was  the  history  of  the  complaint. 
At  last  the  patient  mentioned  a  tetter  which  had  covered  all  the  scrotum,  and 
extended  to  the  perineum  and  margin  of  the  anus.  I  then  inquired  if  he 
had  ever  experienced  spermatic  discharges  during  the  passage  of  feces,  and 
I  soon  learned  from  the  details  into  which  he  entered  that  he  had  been  sub- 
ject to  spermatorrhoea  during  twenty-five  years  without  suspecting  it.  He 
had  always  thought  that  the  urethral  discharge  during  defecation  consisted 
of  mucus,  and  had  never  attached  the  least  importance  to  it.  These  dis- 
charges were  not  habitual  nor  equally  copious  at  all  times,  and  he  was  often 
quite  free  from  them  during  many  months.  As  well  as  he  could  recollect, 
these  periods  of  immunity  were  when  he  was  affected  by  cutaneous  eruptions. 
He  even  thought  that  his  ''''humors"  escaped  with  the  urine  when  he  saw  the 
spermatic  discharges  reappear,  and  he  then  experienced  in  the  rectum  and 
bladder  a  heat  and  irritation  which  he  was  only  able  to  relieve  by  means  of 
injections.  From  the  first  occurrence  of  these  involuntary  discharges  his 
erections  and  sexual  desire  had  constantly  diminished,  and  had  left  him 
entirely  for  several  years ;  this  he  attributed  solely  to  the  effects  of  age. 
His  urine  was  often  muddy  and  flocculent  for  a  fortnight,  and  then  became 
limpid  during  a  variable  length  of  time. 

AH  these  circumstances  combined,  were  much  too  clear  to  leave  the  slight- 
est doubt  as  to  the  nature  of  the  disorder ;  I  therefore  recommended  him  to 
take  the  natural  sulphuretted  waters,  and  he  went  to  those  of  Vernet,  near 
Perpignan.  After  seven  or  eight  baths  a  lively  itching  came  on  in  his  skin, 
especially  on  the  legs.  Numbers  of  small  pimples  appeared,  from  which 
oozed  for  a  month  so  considerable  a  quantity  of  reddish  serosity,  that  the 
patient  was  obliged  to  surround  his  limbs  twice  a  day  with  several  folds  of 
linen.  At  length  this  discharge  gradually  diminished,  and  the  epidermis 
came  off  in  patches  over  the  whole  surface  of  the  body. 


90  CAUSES    OF   SPERMATOEEHCEA. 

Durinw  this  time  a  complete  change  took  place  in  the  economy:  the 
feces  were  passed  easily  and  regularly ;  the  appetite  increased  ;  the  invo- 
luntary spermatic  discbarges  disappeared;  the  stomach  digested  with  equal 
facility  all  kinds  of  food,  and  bore  the  patient's  taking  wine  ;  his  erections 
reappeared,  and  in  fact  M.  D at  fifty-six  years  of  age  experienced  al- 
most a  return  to  youth. 

In  this  case  spcrmatorrhoga  was  unsuspected  during  twenty-five 
years,  and  the  unhappy  patient  who  thus  suffered  had  passed  during 
all  the  time  for  a  hypochondriac.  Enemas  and  medicines  had  been 
prescribed  for  him,  without  any  attempt  being  made  to  seek  the  cause 
of  his  disease.  I  hope  that  these  cases  will  in  future  receive  more 
attention  from  medical  men  ;  although  they  do  not  speedily  cause 
death,  it  must  be  admitted  that  they  render  existence  wretched. 

How  was  it  that  this  patient  could  so  long  support  so  serious  a 
disease  ?  Probably  because  it  was  not  constant.  The  spermatic  dis- 
charges, in  the  commencement,  seem  only  to  have  appeared  when 
initation  occurred  in  the  genitourinary  organs  or  rectum.  At  last, 
however,  they  threatened  the  patient's  life,  and  suspicions  arose  of 
the  presence  of  cerebral  disease,  or  at  least  of  the  danger  of  apoplexy. 

Causes. — The  cases  I  have  related  are  sufficient  to  show  the  inti- 
mate connection  that  exists  between  the  genito-urinary  mucous  mem- 
branes and  the  skin,  especially  that  of  the  scrotum  and  perineum. 
I  do  not,  however,  mean  to  infer  that  the  connection  between  the 
mucous  membrane  and  the  skin  is  more  intimate  or  special  in  the 
genito-urinary  than  in  the  other  organs  of  the  body.  It  depends  on 
the  same  cause,  viz :  the  analogy  of  function  between  the  mucous 
and  the  cutaneous  tissues.  In  the  tenth  and  eleventh  cases  which  I 
have  related,  the  genito-urinary  organs  were  the  last  affected  ;  the 
law,  therefore,  is  a  general  one,  but  I  can  only  here  consider  that 
part  of  it  which  relates  to  spermatorrhoea. 

Nevertheless,  cutaneous  affections  alone  have  not,  in  most  cases, 
been  sufficient  for  the  production  of  this  disease,  for  I  have  already 
stated  that  its  causes  rarely  act  singly.  It  is,  however,  necessary  to 
consider  them  singly  when  we  wish  to  discover  the  influence  due  to 
each,  and  we  ought  to  take  into  account  all  the  circumstances  which 
may  contribute  to  produce  so  serious  a  disorder. 

I  have  reported  in  the  preceding  chapter  an  example  (case  ninth) 
of  blennorrhagia  complicated  with  cutaneous  disease,  for  the  cure  of 
which  it  was  necessary  to  employ  special  remedies  ;  in  the  eleventh 
and  twelfth  cases,  urethral  discharges  were  present  in  more  or  less 
severity  and  frequency.  It  may  appear  that  I  should  not  have  se- 
parated cases  so  much  resembling  each  other,  but  I  have  been  guided 
in  so  doing  by  the  greater  predominance  of  one  or  the  other  predis- 
posing affection. 

There  is  certainly  no  reason  Avhy  an  individual  affected  by  cutane- 
ous diseases  should  not  expose  himself  to  the  risk  of  blennorrhagic 
contagion,  and  there  is  on  the  other  hand  every  reason  why  he  should 


CUTANEOUS   AFFECTIONS.  91 

be  easily  infected  by  such  exposure ;  I  think,  liowever,  that  we  too 
generally  confound  the  discharges  to  which  such  persons  are  subject 
with  ordinary  blennorrhagia,  and  if  the  patients  speak  of  old  cutaneous 
affections  which  have  disappeared  on  the  occurrence  of  the  discharge, 
we  too  often  smile,  and,  without  taking  further  notice,  prescribe  the 
anti-blennorrhagic  remedy  whicb  we  are  in  the  habit  of  using  in  all 
cases.  Even  well  educated  and  experienced  practitioners  constantly 
act  thus,  from  not  having  sufficiently  considered  special  cases;  these 
cases,  nevertheless,  occur  often  enough  to  merit  serious  attention. 

One  of  my  friends,  who  had  been  aftected  for  a  long  time  by  a 
pruriginous  eruption,  consulted  an  empiric,  who  ordered  an  ointment 
to  be  applied  over  all  his  body  for  its  cure.  He  was  scarcely  well 
when  he  married.  A  few  days  after,  an  abundant  greenish  discharge 
appeared  from  the  urethra,  attended  by  pain,  and  all  the  symptoms 
of  violent  blennorrhagia.  At  this  he  was  much  alarmed,  and  con- 
sulted me.  Knowing  his  history,  I  did  not  share  his  suspicions,  but 
I  recommended  him  to  wear  flannel  from  head  to  foot;  in  a  few  days 
the  eruption  reappeared,  and  the  discharge  subsided  spontaneously. 

I  have  at  this  time  under  my  care  a  patient  who,  at  the  age  of 
fourteen,  suffered  from  an  eruption  on  the  scalp ;  this  disappeared 
about  the  age  of  nineteen,  and  was  followed  by  chronic  inflammation 
of  the  pulmonary  mucous  membrane.  After  the  cure  of  this  affection, 
pain  in  the  neck  of  the  bladder,  accompanied  w^ith  uneasiness,  acute 
cutting  pain,  and  weight  in  the  rectum,  came  on  without  any  evident 
causes;  urethral  discharge  appeared;  the  spermatic  cord  and  testi- 
cles became  swollen  and  painful,  and  the  patient  is  now  the  victim 
of  spermatorrhoea,  "^ith  all  its  accompanying  disorders. 

In  another  case,  for  which  I  have  been  recently  consulted,  the 
patient  had  never  had  sexual  intercourse.  He  suffered  from  cuta- 
neous aff'ections  in  early  life,  and  at  the  age  of  eighteen  experienced 
inflammation  of  the  testicles  from  excessive  excitement  caused  by 
reading  an  obscene  book,  and  two  years  afterwards,  after  unsuccess- 
ful attempts  to  obtain  the  favors  of  a  female,  a  severe  blennorrhagia 
occurred,  which  lasted  nine  months. 

After  these  facts,  we  should  think  twice  before  we  pronounce  on 
the  nature  of  a  urethral  discharge  occurring  in  a  person  subject  to 
cutaneous  eruptions,  especially  when  their  suppression  has  previously 
been  followed  by  inflammation  of  some  other  mucous  membrane.  Yet 
we  must  always  bear  in  mind  that  these  persons  are  liable,  in  common 
with  the  rest  of  mankind,  to  the  occurrence  of  blennorrhagia,  which 
would  even  put  on,  in  their  particular  cases,  greater  virulence  than 
usual,  and  must  therefore  greatly  increase  the  predisposition  of  per- 
sons subject  to  cutaneous  diseases  to  suffer  from  spermatorrhoea. 

We  find  in  these  cases,  as  in  those  recorded  in  the  second  chapter, 
that  anti-venereal  treatment  is  useless,  and  frequently  injurious. 

Mode  of  Action. — In  what  manner  do  cutaneous  affections  operate 
in  producing  spermatorrhoea?  The  cases  I  have  reported  are  suffi- 
cient to  show  that  they  act  by  a  metastasis  to  the  mucous  membrane 


92  CAUSES    OF    SPEEMATORRHfEA. 

of  the  genito-urinary  apparatus.  Thus  the  patient  suffered  from  re- 
peated attacks  of  urethritis  (as  in  the  eleventh  case),  acute  or  chronic 
cystitis  (as  in  the  tenth  case),  active  irritations  of  the  bladder,  inflam- 
mation of  the  testicles  (tenth  case),  or  the  prostate,  and  pains  in  the 
spermatic  cords.  We  find  then  in  these  patients  the  same  symptoms 
that  are  manifested  by  those  in  whonj  spermatorrhoea  has  arisen  from 
contaf^ious  urethritis.  The  metastasis  of  cutaneous  affections  to  the 
urethral  mucous  membrane,  therefore,  produces  the  same  effects  as 
the  blennorrhagic  virus,  and  the  irritation  extends  in  the  same  course 
along  the  seminal  passages. 

Irritation  of  the  Rectum. — Several  of  my  patients  have  suffered 
from  affections  of  the  rectum  of  which  I  have  given  no  account  in  the 
preceding  chapters.  These  affections  have  consisted  of  a  sense  of 
heat,  darting  pains,  uneasiness,  and  a  feeling  of  pulsation  extending 
more  or  less  high  in  the  intestine  (as  in  the  twelfth  case).  These 
symptoms  show  that  the  cutaneous  irritation  had  extended  to  the 
mucous  lining  of  the  rectum,  as  well  as  to  that  of  the  genito-urinary 
organs.  Such  a  complication  must  increase  greatly  the  chance  of 
spermatorrhoea  occurring,  by  provoking  a  spasmodic  contraction  of 
the  rectum,  whence  results  an  obstacle  to  the  passage  of  feces,  and 
a  disposition  to  contraction  in  the  seminal  vesicles. 

In  the  next  chapter  I  shall  consider  the  causes  of  spermatorrhcea 
Avhich  are  connected  with  the  rectum,  and  I  shall  only  now  observe, 
in  passing,  that  their  symptoms  must  not  be  confounded  with  those 
arising  from  irritation  of  the  prostate.  In  both  cases,  constipation 
and  a  sense  of  weight,  heat,  and  uneasiness  in  the  rectum,  may  be 
present;  but  when  these  symptoms  arise  from  a^  eruptive  affection, 
an  intolerable  itching,  and  heat  at  the  edge  of  the  anus  are  felt,  and 
on  examining  the  parts,  they  are  found  red,  excoriated,  and  wet ;  on 
drawing  out  the  folds  of  the  skin,  a  mucous  and  sometimes  a  puru- 
lent discharge  is  perceptible,  and  the  portions  of  mucous  membrane 
which  can  be  brought  into  view  are  seen  to  be  in  the  same  condition: 
in  a  word,  the  margin  of  the  anus  presents  unequivocal  marks  of 
cutaneous  disease. 

It  is  important  to  establish  this  distinction,  because,  in  the  first 
case,  cauterization  of  the  prostatic  portion  of  the  urethra  may  put  an 
end  to  the  chronic  inflammation  going  on  there  ;  but,  in  the  second 
case,  symptoms  which  have  their  seat  in  the  rectum  are  due  to  a 
special  affection  of  its  mucous  membrane.  It  is,  indeed,  true  that 
this  affection  is  similar  to  that  of  the  urethra,  and  that  it  arises 
from  the  same  cause;  but  the  cure  of  the  urethral  inflammation  would 
have  no  effect  on  that  present  in  the  rectum,  and  we  shall  presently 
see  that  the  latter  may  suffice  to  excite  or  keep  up  spermatorrhoea  to 
a  sufRcient  extent  to  alter  the  health  seriously. 

Treatment.  —  The  only  means  that  have  been  successfully  em- 
ployed in  cases  of  this  nature,  are  cauterization  and  the  use  of  the 
sulphuretted  waters. 


(    93    ) 


CHAPTER  V. 

CAUSES  OF  SPERMATORRHOEA. 
Influence  of  the  Rectum. 

I  HAVE  hitherto  examined  those  causes  which  influence  the  sper- 
matic organs  by  their  direct  action  on  the  urethral  mucous  membrane. 
1  now  proceed  to  consider  such  as  act  on  the  seminal  vesicles  by 
the  mechanical  and  sympathetic  influence  of  the  rectum. 

CASE  XV. 

Spermatorrhoea  from  a  mechanical  obstacle  to  defecation — Division  of  the 
stricture — Rapid  and  complete  cure. 

Nicholas  G ,  the  guard  of  a  diligence,  of  strong  constitution,  at  the 

age  of  twenty-five  contracted  a  chancre,  followed  by  bubo  and  warts.  This 
attack  of  syphilis  was  treated  with  mercurials,  without  the  patient  giving  up 
his  employment,  and,  notwithstanding  the  fatigue  consequent  on  his  frequent 
journeys,  at  the  expiration  of  six  weeks  all  the  symptoms  had  disappeared. 
Shortly  afterwards  he  experienced  difficulty  in  defecation,  which  slowly  in- 
creased, so  that  in  the  course  of  four  or  five  years  considerable  efforts  were 
necessary  to  evacuate  the  rectum.  The  feces  were  flattened,  like  a  ribbon, 
four  or  five  lines  in  width  and  about  a  line  in  thickness. 

From  this  time  G 's  health  became  gradually  disordered;  his  appetite 

diminished,  his  digestion  was  impaired,  and  accompanied  with  the  develop- 
ment of  flatus ;  he  lost  flesh,  and  his  weakness  increased  daily ;  his  memory 
was  impaired,  and  the  genital  organs  underwent  the  same  changes  in  their 
functions.  When  he  first  consulted  me  he  had  scarcely  any  venereal  desires, 
his  erections  were  imperfect,  coitus  was  rarely  possible,  and  ejaculation  was 
long  in  taking  place ;  sometimes  it  did  not  even  occur  at  all,  and  it  was 
never  accompanied  by  any  lively  sensation. 

The  concurrence  of  all  these  symptoms  convinced  me  of  the  presence  of 
spermatorrhoea.  The  patient  told  me  that  for  four  years  he  had  been  in  the 
habit  of  passing  semen  while  at  stool,  and  that  its  discharge  in  general  bore 
a  proportion  to  the  efi"orts  necessary  for  the  expulsion  of  the  feces  ;  on  this 
account,  in  order  to  render  them  as  fluid  as  possible,  he  had  reduced  himself 
to  a  vegetable  and  milk  diet.  He  had  often  attempted  to  use  enemata,  but 
had  been  unable  to  succeed. 

The  abundant  spermatic  discharges  had  so  worn  this  patient  out,  that  at 
the  age  of  thirty-four  he  presented  the  appearance  of  a  man  aged  sixty. 

On  examination,  I  discovered,  about  two  inches  from  the  anus,  a  nearly 
circular  obstruction,  of  about  half  a  line  in  thickness,  having  an  irregular 
opening  in  its  centre  which  would  barely  admit  the  extremity  of  the  fore- 


94:  CAUSES    OF   SPERMATORRHEA. 

finger.     This  kind  of  diaphragm  obstructed  the  passage  of  fecal  matter ;  it 
was  thin  and  soft,  and  felt  like  a  cicatrix. 

I  made  transverse  incisions  through  the  obstruction  by  means  of  a  straight 
probe-pointed  bistoury  passed  along  the  index  finger.  These  incisions 
were  of  very  trifling  depth,  and  I  afterwards  dilated  the  opening  by  intro- 
ducing- my  finger  deeply,  and  pressing  it  forcibly  in  the  direction  of  each 
wound,  until  by  tearing  I  reached  the  walls  of  the  intestine.  Four  loose 
•flaps  resulted  from  this  operation,  and  I  prevented  their  reunion  by  the 
frequent  introduction  of  my  finger.  The  operation  was  attended  with  very 
little  pain  or  loss  of  blood.  Some  time  afterwards  I  showed  the  patient 
how  to  introduce  a  rectum  bougie,  of  sufiicient  size  to  dilate  the  portion 
of  gut  which  had  been  operated  on ;  this  I  advised  him  to  practise  daily  for 
some  time.  This  simple  means  proved  suflficient  to  procure  separate  cica- 
trization of  the  four  flaps,  after  which,  the  expulsion  of  the  feces  took  place 
without  difficulty,  and  the  spermatic  discharges  ceased.     All  his  functions 

were  soon  restored  to  their  natural  state,  and  Nicholas  G resumed  his 

former  occupation. 

This  case  gives  a  very  clear  view  of  the  mecbanical  influence  of 
constipation  in  producing  spermatic  discharge  during  the  passage  of 
feces.  The  sole  cause  of  the  spermatorrhoea  was  the  membranous 
obstacle  above  the  sphincter  ;  and  the  discharge  was  caused  simply 
by  mechanical  pressure  on  the  seminal  vesicles  during  the  violent 
efforts  the  patient  was  compelled  to  make  in  order  to  force  the  feces 
through  a  narrow  opening.  As  soon  as  the  obstacle  was  removed, 
the  spermatorrhoea  ceased,  and  all  the  symptoms  arising  from  it  dis- 
appeared. The  effects  of  mechanical  compression  were  in  this  case 
then  quite  unmistakable. 

Coitus  was  very  long  before  ejaculation  took  place ;  sometimes 
even  the  completion  of  the  act  was  impossible,  and  it  was  never  at- 
tended by  lively  sensations.  The  cause  of  all  this  was  that  the 
seminal  vesicles  contained  little  and  badly  formed  secretion ;  but 
these  organs  were  not  in  a  state  of  irritation,  and  the  ejaculatory 
canals  were  neither  irritable  nor  relaxed.  In  most  cases  of  diurnal 
pollution,  ejaculation  is,  on  the  contrary,  very  rapid,  because  the 
spermatic  organs  are  either  irritated  or  relaxed,  if  they  are  not  at 
the  same  time  in  both  these  conditions. 

CASE  XVI. 

Spermatorrlioea  induced  hy  chronic  diarrhoea,  and  hept  up  hy  a  mechanical 
obstacle  to  defecation — Removal  of  a  scirrhous  tumor  from  the  anus — 
liajnd  and  perfect  cure. 

M ,  of  good  constitution,  entered  the  army  at  the  age  of  seventeen, 

and  served  for  eighteen  years,  during  which  he  was  exposed  to  considerable 
hardships.     He  also  committed  excesses  of  all  kinds.     His  health,  however, 

continued  excellent.       In  1814,  M ,  then  aged  thirty-five,  contracted 

blennorrhagia,  which  he  neglected;  the  discharge  diminished,  but  did   not 
entirely  cease  before  1816,  when  he  quitted  the  army.     In   1820,  M 


INFLUENCE  OF  THE  RECTUM.  95 

luarried,  but  did  not  indulge  in  any  excesses.  Some  time  afterwards,  having 
been  engaged  as  concierge  to  a  club,  be  passed  many  nights  almost  without 
lying  down.  In  1824  he  was  suddenly  seized  with  violent  colic,  which  was 
relieved  by  means  of  emollient  injections,  repeated  baths,  and  a  severe  re- 
gimen, but  which  did  not  entirely  leave  him. 

Two  years  afterwards  he  had  a  severe  hemorrhage  from  the  rectum,  ac- 
companied with  very  painful  tenesmus,  during  the  violent  spasms  of  which 
he  noticed  that  he  passed  semen.  This  hemorrhage  relieved  the  colicky 
pains  he  had  suffered  from,  but  a  dysentery  remained,  which  kept  up  the 
tenesmus  and  with  it  the  involuntary  seminal  emissions,  and  caused  the 
prolapse  of  several  hemorrhoidal  tumors  with  eversion  of  the  mucous  mem- 
brane of  the  rectum.     From  this  period  M 's  health  became  more  and 

more  disordered;  he  lost  his  habitual  spirits  together  with  his  sexual  appetite, 
and  his  sight  as  well  as  his  memory  and  physical  strength  became  weakened, 
so  that  in  1827  he  was  obliged  to  give  up  his  occupation  of  concierge. 
During  the  years  1827  and  1828,  the  chronic  diarrhoea  decreased  in  severity, 
and  in  1829,  it  had  become  much  less  frequent.  At  length,  in  1830,  it 
was  replaced  by  a  very  obstinate  constipation,  which  in  its  turn  also  became 
the  cause  of  spermatorrhoea,  and  increased  the  swelling  caused  by  the  ha3- 
niorrhoids  and  the  prolapsed  mucous  membrane  of  the  rectum.  This  swell- 
ing was  irreducible  ;  it  increased  in  hardness,  was  irritated  by  the  friction 
of  his  clothes,  and  at  last  assumed  a  scii'rhous  consistency.  Its  presence 
alone  formed  a  considerable  obstacle  to  defecation.     On  the  28th  of  March, 

1831,  M applied  at  the  Hospital  St.  Eloi,  in  the  following  condition: 

He  was  fifty-one  years  of  age ;  extremely  pale ;  his  face  pale  yellow ;  skin 
woolly ;  hair  black  ;  weakness  excessive  ;  sensibility  very  great ;  profound 
melancholy;  habitual  hypochondriasis;  digestion  difficult,  especially  after 
the  use  of  animal  food  ;  defecation  rendered  troublesome  by  a  red,  hard 
swelling,  five  or  six  lines  in  diameter  across  its  base,  projecting  about  an 
inch,  and  occupying  about  half  the  circumference  of  the  anus;  involuntary 
discharges  of  semen  during  the  efforts  necessary  to  procure  a  fecal  evacua- 
tion ;  the  emission  of  urine  followed  by  a  discharge  of  a  glairy,  limpid,  and 
sticky  matter;  no  erections  during  a  long  period;  absence  of  all  sexual  im- 
pulse; frequent  attacks  of  vertigo;  dazzling  of  the  eyes;  buzzing  in  the 
ears ;  attacks  of  heat  towards  the  head  from  the  slighest  cause.  The 
tumor  of  which  I  have  spoken  resembled  a  large  cock's  comb;  contracted 
haemorrhoids  were  situated  around  it;  and  it  seemed  to  have  arisen  from  the 
prolapsus  of  internal  haemorrhoids,  which  had  brought  down  with  them  a 
portion  of  the  mucous  membrane  of  the  rectum.  The  contraction  of  the 
sphincter  ani  bad  prevented  the  return  of  this  tumor,  and  had  increased 
its  swelling,  and  the  friction  of  the  patient's  clothes  had  caused  repeated  in- 
flammation and  degeneration  of  its  tissue.  The  base  of  the  tumor  occupied 
more  than  half  the  circumference  of  the  anus,  and  extended  above  the 
sphincter  ani.  It  was  about  six  lines  in  thickness,  and  its  feel  was  scir- 
rhous ;  a  sanious  discharge  exuded  from  its  surface,  some  points  of  which  had 
even  begun  to  ulcerate.  It  was,  therefore,  evident  that  no  time  should  be 
lost  if  it  were  intended  to  remove  this  tumor;  the  patient  was  anxious  for 
the  operation,  and  had  previously  asked  several  surgeons  to  perform  it ; 
but  these  gentlemen  had  refused  on  account  of  the  depth  to  which  the  dis- 
eased tissue  extended. 

By  gentle  and  gradual  traction  on  the  tumor  I  was  able  to  bring  it  en- 
tirely through  the  sphincter,  so  as  to  bring  the  healthy  mucous  membrane 


96  CAUSES    OF    SPERMATOKRHCEA. 

into  view.  On  the  25th  of  March,  therefore,  I  commenced  its  removal  by 
an  incision  in  the  healthy  mucous  membrane,  and  to  arrest  the  severe  he- 
morrhao-e  which  ensued,  I  cauterized  the  bottom  of  the  wound  with  a  fine 
heated  "iron.  The  tumor  was  then  dissected  out,  the  parts  being  touched 
with  the  actual  cautery  as  they  were  divided.  After  the  entii-e  removal  of 
the  tumor,  the  greater  portion  of  the  wound  ascended  within  the  sphincter. 

Slight  inflammatory  symptoms  supervened,  which  yielded  to  bleeding,  &c., 
suppuration  was  established,  and  the  cicatrization  of  the  wound  was  com- 
pleted by  degrees.  The  first  few  days  after  the  operation  the  patient  was 
unable  to  void  his  urine  without  the  use  of  a  catheter,  and  for  some  time 
afterwards  he  micturated  very  frequently. 

On  the  first  of  May  cicatrization  was  nearly  completed,  the  feces  had  re- 
gained their  normal  consistence  and  were  passed  daily  without  difficulty, 
their  passage  no  longer  giving  rise  to  involuntary  spermatic  discharge.  The 
patient  regained  his  strength  and  spirits ;  his  appetite  returned,  and  his  di- 
gestion was  performed  easily;  his  strength  and  stoutness  increased  daily. 
About  the  middle  of  the  month  his  erections  reappeared  during  the  night, 
and  afterwards  became  more  frequent  and  prolonged ;  his  cerebral  functions 
followed  the  same  course  in  their  re-establishment ;  the  dazzling  of  sight 

and  cerebral  congestions  disappeared ;  and  M left  the  hospital  on  the 

24th  of  May,  perfectly  restored  to  health. 

Three  years  afterwards,  when  I  was  summoned  to  Clermont  to  preside 
over  a  medical  inquiry,  M called  on  me;  I  recognized  him  with  diffi- 
culty, so  much  was  his  countenance  changed.  It  is  scarcely  necessary  for 
me  to  say,  that  he  had  resumed  his  conjugal  duties,  and  his  occupation  of 
concierge.  The  cicatrix  of  the  anus  was  thin  and  soft,  and  did  not  interfere 
with  defecation. 

The  latter  part  of  this  case  exactly  resembles  the  preceding  one, 
and  the  results  of  the  operation  prove  that  the  involuntary  spermatic 
discharges  were  only  kept  up  by  the  mechanical  obstacle  to  defeca- 
tion. 

But  the  diarrhoea  which  had  caused  the  prolapse  of  the  hseraor- 
rhoids,  and  the  formation  of  the  scirrhous  tumor,  was  also  accom- 
panied by  frequent  involuntary  emissions.  At  this  time,  then,  the 
seminal  vesicles  could  not  have  been  subjected  to  compression  as  the 
feces  were  liquid,  and  remained  a  very  short  time  in  the  rectum  ; 
we  must,  therefore,  admit  that  the  seminal  vesicles  participated  in 
the  irritation  of  the  rectum — that  they  were  afi'ected  by  the  spas- 
modic contraction  which  took  place  in  the  gut — in  a  word,  that  they 
were  influenced  by  the  tenesmus. 

This  case,  then,  presents  a  remarkable  instance  of  the  double  in- 
fluence possessed  by  the  rectum  over  the  seminal  vesicles ;  in  the 
beginning  of  the  disease  this  influence  was  essentially  vital  ;  at  its 
termination  it  was  simply  mechanical.  Both  phenomena  produced 
the  same  results,  but  they  were  quite  sufiiciently  distinguished  from 
one  another  not  to  be  confounded  together. 

It  was  worthy  of  remark,  also,  that  the  patient,  immediately  after 
the  operation,  was  unable  to  pass  his  urine  without  the  assistance  of 
a  catheter,  and  that  after  a  short  time  he  experienced  a  frequent  de- 


INFLUENCE  OF  THE  KECTUM.  97 

sire  to  micturate.     These  two  phenomena  show  the  intimate  con- 
nection that  exists  between  the  anus  and  the  neck  of  the  bladder. 

This  case,  then,  exemplifies  the  influence  of  the  rectum  over  the 
urinary  organs,  in  both  its  different  forms. 


CxiSE  XVII. 

Hsemorrlioich  from  the  age  of  'puheriy — Dificidty  in  evacuating  tlie  rectum 
at  the  age  of  twenty-eight — Spermatorrhma — Cure. 

M.  A ,  of  a  sanguine  temperament,  at  fifteen  years  of  age  was  addicted 

to  masturbation ;  soon  after  he  had  a  discharge  of  blood  from  bssmorrhoids, 
which  he  regarded  as  a  consequence  of  his  injurious  habit,  and  consequently 
abandoned  it  sufficiently  early  for  his  health  to  remain  uninjured ;  but  the 
haemorrhoids  teased  him  much,  especially  when  some  time  after  he  entered 
the  army.  They  were  relieved,  however,  after  a  campaign  in  Spain,  where 
the  patient  suffered  much  from  heat.  By  returning  to  his  home  and  by 
leading  a  less  active  life,  he  hoped  with  care  to  rid  himself  of  his  troublesome 
affection ;  the  reverse  happened,  however — his  diet  being  more  stimulating 
and  his  habits  being  sedentary,  the  haemorrhoids  increased  in  number  and 
size.  His  stools  were  followed  by  a  more  or  less  abundant  discharge  of  blood. 
The  internal  hjemorrhoids  were  protruded  and  formed  a  voluminous  and 
painful  mass,  which  could  only  be  reduced  by  a  long  continued  pressure. 
After  a  time  these  hemorrhoidal  tumors  becoming  irritated  and  swollen,  pre- 
sented an  obstacle  to  the  discharge  of  feces ;  a  larger  portion  of  intestine 
protruded,  and  was  returned  with  great  difficulty.  The  patient  now  perceived 
that  in  his  efforts  at  stool  he  passed  a  large  quantity  of  semen,  his  health 
broke  up  by  degrees,  he  felt  debilitated,  his  digestion  became  disordered, 
his  sleep  was  broken  and  unrefreshing ;  his  temper  was  soured,  he  often  ex- 
perienced sensations  of  stunning,  vertigo,  and  sometimes  even  fainting  fits. 

Emollient  injections,  baths,  and  demulcents  appeared  to  benefit  him  at 
first,  but  he  soon  perceived  that  they  increased  the  relaxation  of  the  parts, 
and  favored  both  the  prolapsus  of  the  rectum  and  the  spermatic  discharges. 

This  state  had  lasted  four  months,  when  the  patient  first  consulted  me. 
He  was  twenty-eight  years  of  age,  and  had  the  appearance  of  being  forty; 
his  muscles  were  well  developed,  but  he  was,  notwithstanding,  without 
strength  or  energy.  I  first  relieved  the  irritation  of  the  rectum  by  lave- 
ments of  decoction  of  poppy-heads,  and  afterwards  used  slightly  stimulating 
ointment  containing  balsamic  applications,  at  the  same  time  that  quinine 
and  preparations  of  iron  were  administered. 

Under  this  treatment  the  mucous  membrane  of  the  rectum  by  degrees 
regained  its  tone;  the  haemorrhoids  became  less  sensitive  and  less  volumi- 
nous, and  many  of  them  withered  away.  The  prolapsus  of  the  rectum  dis- 
appeared gradually,  and  the  seminal  discharges  diminished,  at  the  same  time 
removing  the  symptoms  that  depended  on  them. 

Haemorrhoids  at  the  early  age  of  fifteen  are  rare  ;  I  cannot,  how- 
ever, believe  that  masturbation  alone  caused  their  appearance  in  this 
patient,  but  I  think  it  probable  that  he  had  a  considerable  predis- 


98  CAUSES    OF    SPEEMATORRH(EA. 

position  to  them.  I  do  not  suppose  that  the  habit  he  practised  for 
a  short  time  in  his  youth  had  any  influence  in  causing  the  sperma- 
torrhoea, for  it  is  very  easy  to  account  for  spermatic  discharges  in 
such  a  case  without  referring  to  very  remote  causes.  We  must 
then  ref^ard  this  case  as  another  example  of  the  influence  which  ob- 
struction to  the  passage  of  feces  exercises  on  the  seminal  vesicles. 


CASE  XVIII. 

Blennorrliagia — Constipation — Fissure  of  the  anus — Discharge  of  semen  at 
stool — Profound  hi/povhondriasis — Desire  of  committing  suicide — Diar- 
rhoea—  Cure  of  the  fissure  of  the  anus  —  Disappearance  of  the  other 
symptoms. 

At  the  age  of  twenty-four  F.  B contracted  blennorrhagia,  which  was 

accompanied  with  weight  in  the  region  of  the  prostate.  By  leeches  and 
baths  the  pains  were  relieved,  and  the  discharge  reduced  to  a  slight  gleet. 
Soon  afterwards  the  left  testicle  became  swollen  and  very  painful,  and  the 
discharge  increased  in  consequence  of  energetic  and  long  continued  erec-, 
tions.  The  patient  used  leeches  and  hip-baths,  and  the  swelling  of  the  tes- 
ticle diminished,  but  the  discharge  continued.  For  three  or  four  years  this 
testicle  continued  very  tender;  it  swelled  on  several  occasions,  and  became 
painful  in  consequence  of  slight  venereal  excitement,  the  urethral  discharge 
increasing  at  the  same  time.  These  phenomena  returned  every  spring  during 
four  years. 

In  order  to  cure  these  symptoms  F.  B took  the  Rob  de  Laffecteur,^ 

after  the  second  bottle  of  which  an  obstinate  constipation  supervened. 

Defecation  now  became  very  painful,  and  the  feces  were  covered  with 
blood.  The  patient  had  recourse  to  enemata  without  benefifc;  during  their 
administration  he  felt  as  if  the  "anus  were  torn  by  heated  razors."  This 
state  had  lasted  several  months  when  he  experienced  attacks  of  vertigo 
after  going  to  stool,  and  sudden  attacks  of  cerebral  congestion,  passing  oif 
rapidly,  either  while  walking  or  engaged  in  any  kind  of  employment:  his 
moral  condition  became  affected  ;  he  fell  by  degrees  into  a  deep  melancholy  ; 
depressing  thoughts  arose  before  him  incessantly ;  he  seemed  compelled  to 
seek  solitude  and  darkness;  he  felt  a  horror  of  suicide,  but  nevertheless  he 
seemed  always  to  be  driven  towards  it.  Wrapped  up  in  his  melancholy 
thoughts  he  spoke  to  no  one,  and  if  his  friends  endeavored  to  attract  his  at- 
tention he  responded  to  them  rudely;  he  felt  his  venereal  desires  constantly 
diminish;  but  this  did  not  aifect  him  so  much  as  his  moral  position;  he  held 
suicide  in  abhorrence,  yet  he  felt  impelled  towards  it  in  spite  of  his  will;  his 
reason  wandered,  until  at  length  he  believed  himself  possessed  by  the  devil, 
and  he  spent  hours  together  in  praying  to  be  delivered  from  his  tempta- 
tions. A  constant  feeling  of  hunger  annoyed  him,  though  he  ate  often  and 
greedily ;    his  digestion  was  painful  and    laborious.     Notwithstanding  the 


'  Rob  (le  LaflFecteur  is  composed  of  a  strong  decoction  of  the  Arvndo  Phragmitis, 
or  bulrush,  with  sarsaparilla  and  aniseeds,  evaporated,  and  made  into  a  Kobor  syrup, 
by  the  addition  of  sugar.  To  this  a  solution  of  the  bichloride  of  mercury  is  after- 
wards added. 


INFLUENCE  OF  THE  KECTUM.  99 

repeated  use  of  leeches,  demulcents,  and  baths,  these  symptoms  increased 
to  a  frightful  extent;  his  sufferings  indeed  were  generally  greatest  on  quitting 
the  bath.  One  day  whilst  at  stool  he  noticed  the  evacuation  of  a  quantity 
of  whitish  and  viscid  matter  which  he  fancied  was  semen  ;  from  that  time 
his  attention  being  called  to  the  fact,  he  observed  that  he  seldom  had  an 
evacuation  without  more  or  less  spermatic  discharge  ;  he  noticed  also  that 
the  matter  in  its  passage  produced  a  kind  of  tickling  accompanied  with  heat 
in  the  urethra. 

After  having  passed  sis  months  in  this  deplorable  condition,  the  patient 
suffered  from  a  serious  attack  of  indigestion,  followed  by  a  very  copious 
diarrhoea  that  lasted  a  fortnight,  and  reduced  him  to  an  extreme  state  of 
debility;  but  after  its  relief  the  feces  regained,  by  degrees,  their  normal 
consistence  and  were  then  passed  without  pain  or  streaks  of  blood ;  the 
spermatic  discharges,  which  had  been  excited  by  efforts  at  stool  no  longer 
took  place,  and  all  the  moral  and  physical  symptoms  above  mentioned  were, 
by  degrees,  completely  and  spontaneously  dissipated.  Several  years  after- 
wards F.  B enjoyed  excellent  health,  all  his  functions,  without  excep- 
tion, being  perfectly  performed. 

In  this  case  the  blennorrhagia  caused  inflammation  of  one  testicle 
and  developed  the  susceptibility  of  the  genital  organs;  consequently, 
therefore,  it  predisposed  them  to  the  occurrence  of  spermatorrhoea ; 
but  the  constipation  brought  on  by  the  use  of  Rob  de  Laffecteur  evi- 
dently was  its  immediate  cause.  The  symptoms  which  ordinarily 
accompany  fissures  of  the  anus  appeared  soon  after;  and  afterwards 
those  arising  from  spermatorrhoea.  The  course  of  events  was  pro- 
bably as  follows:  after  prolonged  constipation,  a  hard  copious  mo- 
tion distended  the  mucous  membrane  lining  the  anus,  more  than 
usual ;  it  gave  way ;  from  that  day  defecation  having  become  painful 
the  patient  put  it  off  as  long  as  possible ;  the  hardened  and  accumu- 
lated feces  in  their  turn  increased  the  fissure  in  the  mucous  mem- 
brane :  thus  it  is  that  fissures  of  the  anus  are  usually  produced 
and  kept  up.  The  diarrhoea,  which  lasted  fifteen  days,  allowed  the 
cicatrix  in  the  mucous  coat  of  the  gut  to  become  firm.  It  is  easy, 
therefore,  to  account  for  the  appearance  and  cessation  of  the  semi- 
nal discharges,  together  with  the  anomalous  symptoms  from  which 
the  patient  suffered  during  six  months. 

1  have  already  shown  hypochondriasis,  in  many  forms,  as  a  conse- 
quence of  spermatorrhoea,  but  in  no  case  previously  reported  did  it 
present  characters  like  those  in  the  case  before  us.  This  young  man, 
naturally  of  a  good  disposition,  was  beset  during  the  whole  course  of 
his  disease,  by  the  most  frightful  propensities ;  he  was  so  revolted  by 
them  that  the  loss  of  his  health  seemed  nothing  when  compared  with 
the  mental  torture  they  entailed  on  him.  His  reason  was  so  shaken 
that  he  considered  the  intervention  of  the  devil  to  be  the  only  mode 
of  explaining  his  evil  impulses  !  To  what  must  we  refer  an  aberra- 
tion of  intellect  which  might  have  produced  such  fatal  results  ? 

But  to  return  to  the  consideration  of  fissures  of  the  anus.  This 
disease,  without  doubt,  often  excites  spermatorrhoea.     The  silence  of 


100  CAUSES    OF    SPERMATORRHOEA. 

authors  on  the  subject  proves  nothing,  for,  notwithstanding  the  ac- 
tivity with  which  during  years  I  have  sought  the  causes  of  sperma- 
torrhoea, I  rarely,  until  lately,  profited  by  the  opportunities  I  had 
of  questioning  patients  on  this  point.  When  the  violent  efforts 
necessary  to  empty  the  rectum,  the  acute  pain  and  spasmodic  con- 
tractions of  which  it  becomes  the  seat,  and  the  disturbances  which 
a  very  slight  excoriation  produces  throughout  the  economy,  are  taken 
into  account,  I  think  it  will  be  readily  allowed  that  fissures  of  the 
anus  may  frequently  induce  abundant  spermatic  evacuations. 

The  patients  fear  to  go  to  stool,  on  account  of  the  pain  the  passage 
of  the  feces  produces ;  these,  therefore,  accumulate  and  harden  in 
the  rectum  ;  when  at  length  the  irritable  intestine  contracts  to  expel 
its  contents,  their  passage  tears  open  the  fissure ;  the  sphincter,  irri- 
tated by  this  increase  of  pain,  contracts  spasmodically,  and  a  con- 
test is  thus  established  between  the  sphincter  and  the  muscular  walls 
of  the  intestine,  aided  by  the  abdominal  muscles.  The  efforts  to 
evacuate  the  intestine  are  so  violent  and  prolonged  that  respiration 
is  suspended;  the  face  becomes  injected  and  purple,  and  blood  appears 
ready  to  start  through  the  skin.  It  is  difficult  to  conceive  how  the 
seminal  vesicles  can,  under  such  circumstances,  escape  compression. 

We  must,  also,  take  into  account  the  fixed  pain  at  the  verge  of 
the  anus,  and  the  spasmodic  state  of  contraction  into  which  all  the 
neighboring  muscles  are  thrown  ;  for  these  phenomena  act  more  or 
less  on  the  genito-urinary  organs.  Lastly,  fissures  of  the  anus  are 
soon  followed  by  changes  in  the  physical  and  moral  state  of  the 
patients,  of  too  serious  a  nature  to  be  attributed  only  to  the  pain 
they  cause.  I  have  seen  young  men  arrive  at  the  hospital  in  a  con- 
dition of  weakness  and  mental  despondency,  contrasting  strongly 
with  the  size  of  their  muscles,  and  the  color  of  their  complexions. 
It  is  especially  after  they  have  evacuated  the  bowels  that  such  pa- 
tients feel  most  worn  out,  broken-spirited,  and  depressed ;  they  have 
generally  lost  all  venereal  desire  ;  their  erections  are  weak,  rare, 
and  incomplete.  I  regret  that  I  have  not  recorded  these  cases,  but 
I  remember  their  circumstances  perfectly,  and  all  things  conduce  to 
make  me  attribute  the  symptoms  to  spermatorrhoea ;  however  this 
may  be,  it  is  a  subject  for  further  research,  to  which  I  wish  to  call 
the  attention  of  the  profession. 

CASE  XIX. 

Horse  exercise —  Constipation — SpermatorrJicea — Imjyotence — Frequent  and 
violent  attacks  of  cerebral  cowjestiun — Ascending  douches — Cauterization 
— Sulphur  baths — Hot  and  cold  douches  on  the  loins  and  perineum — 
Cure. 

M.  De  B consulted   me  in   the   month  of  May,  1834,  respecting  a 

cerebral  afteetion,  on  whose  nature  distinguished  physicians  could  not  agree, 
but  which  all  regarded  as  very  serious. 

He  was  of  a  middle  height,  with  a  large  chest,  aud  a  well  developed 
muscular  system;  his  hair  brown  and  curly,  his  beard  thick,  his  face  full 


I 


INFLUENCE    OF    THE    EECTUM,  101 

and  deeply  colored.  Notwithstanding  these  signs  of  apparent  strength  and 
health,  I  noticed  that  his  knees  were  slightly  bent,  and  that  he  was  unable 
to  remain  longer  standing  without  shifting  the  weight  of  his  body  from  one 
leg  to  the  other;  his  voice  was  weak  and  husky;  the  motions  of  his  tongue 
seemed  embarrassed,  and  he  articulated  his  words  in  a  confused  manner ;  his 
attitude  was  timid,  and  his  manner  had  something  of  incertitude  and  fear ; 
he  had  been  married  fifteen  days. 

His  mother-in-law  and  his  young  wife,  who  accompanied  him,  informed 
me  that  within  this  period  he  had  several  attacks  of  congestion  of  the  brain, 
during  which  his  face  was  highly  injected.  At  the  first  of  these  attacks 
the  surgeon,  called  in  the  night,  had  bled  him  to  the  extent  of  three  pounds, 
in  order  to  prevent  apoplexy ;  repeated  venesection,  and  the  frequent  ap- 
plication of  leeches,  had  relieved  such  attacks  of  congestion,  but  had  not 
prevented  their  recurrence.  The  patient  had  become  subject  to  attacks  of 
vertigo,  and  was  unable  to  look  upwards  without  feeling  giddy ;  his  legs 
had  become  vso  weak  that  he  had  fallen  several  times,  even  when  walking 
on  level  ground ;  his  ideas  had  lost  their  clearness,  and  his  memory  failed 
rapidly. 

These  symptoms  had  spread  consternation  through  both  the  family  of  my 
patient  and  that  of  his  wife,  especially  as  several  practitioners  of  reputation 
were  agreed  as  to  the  existence  of  some  serious  disease  of  the  brain,  although 
they  could  not  decide  as  to  its  nature.  Most  of  them,  however,  were  in- 
clined to  suspect  ramollissement. 

The  countenance  of  the  patient  during  this  recital,  the  coincidence  of  the 
congestion  with  the  period  of  his  marriage,  and  the  bad  effects  of  blood- 
letting, made  me  suspect  the  nature  of  the  disorder,  and  induced  me  to 
question  the  patient  separately.  When  we  were  alone,  he  told  me,  stam- 
mering, that  an  unexpected  occurrence,  immediately  after  his  marriage, 
had  at  first  prevented  any  conjugal  intimacy,  and  that  afterwards  he  bad 
found  himself  completely  impotent.  He  attributed  this  misfQrtune  to  the 
attacks  of  cerebral  congestion,  and  to  the  bleedings  he  had  undergone.  On 
further  inquiry,  however,  I  discovered  that  he  was  affected  by  diurnal  pollur 
tions. 

The  following  is  the  history  I  obtained  from  this  patient  by  dint  of  ques- 
tioning: At  the  age  of  sixteen  he  possessed  a  very  strong  constitution,  and 
an  ardent  and  passionate  character.  At  school  he  contracted  the  habit  of 
masturbation,  and  at  the  end  of  three  months  he  had  frequent  nocturnal 
pollutions,  with  pain  in  the  chest,  and  troublesome  palpitations,  which 
warned  him  of  the  danger  of  the  vice,  and  he  renounced  it  for  ever.  When 
he  became  free  from  the  restraints  of  school,  he  subdued  the  ardor  of  his 
temperament  by  the  most  violent  exercises — especially  that  of  the  chase — 
and  he  attached  himself  to  agricultural  pursuits  with  much  energy. 

This  new  mode  of  life  so  completely  re-established  his  health,  that  he  was 
tormented  by  energetic  and  continual  erections,  to  subdue  which  he  em- 
ployed ryer  baths,  even  in  the  coldest  seasons.  He  never  committed  ex- 
cesses of  any  kind,  and  had  never  suffered  from  any  blennorrhagic  or  syphi- 
litic affection. 

In  1831,  the  erections  were  slightly  mitigated,  but  he  became  very  much 
constipated,  which  he  attributed  to  the  constant  use  of  horse  exercise. 

In  1832,  he  experienced  some  numbness  and  creeping  sensations  in  his 
feet  and  legs. 

In  1833,  frequent  dazzling  of  sight  occurred,  with  vertigo,  difficulty  of 
7 


102  CAUSES    OF    SPERMATOEEHCEA. 

vision,  and  flushes  of  heat,  towards  the  head  and  face ;  the  patient  attributed 
all  these  symptoms  to  the  efifects  of  his  still  increasing  constipation. 

At  the  same  time  that  these  symptoms  occurred,  the  patient's  erections 
became  rarer,  less  energetic,  and  after  a  time  incomplete;  his  fitness  for 
intellectual  labor  diminished ;  the  cerebral  congestions  became  more  frequent, 
and  more  severe;  his  face  became  habitually  very  red;  his  head  burning; 
an  almost  constant  fixed  pain  came  on  in  the  orbits,  and  his  character  be- 
came fickle  and  contradictory. 

His  family  physician,  attributing  all  these  disorders  to  a  state  of  plethora, 
caused  blood  to  be  drawn  several  times  without  benefit. 

In  March,  1834,  M.  De  B engaged  himself  to  a  young  lady,   who 

lived  about  two  leagues  from  his  estate ;  and  in  order  to  visit  her  without 
neglecting  the  care  of  his  property,  he  was  obliged  to  make  long  and  fre- 
quent journeys  on  horseback;  shortly  before  his  marriage,  these  journeys 
became  so  frequent  that  he  might  be  said  to  pass  the  greater  part  of  his 
time  on  horseback.  His  constipation  now  increased  to  such  a  degree  that 
he  passed  forty  days  without  fecal  evacuation;  during  his  efforts  at  stool 
he  passed  semen  in  large  quantities,  and  in  jets,  although  the  penis  remained 
flaccid.  He  had  previously,  several  times,  noticed  the  same  occurrence,  but 
as  he  attributed  it  to  his  long  continued  continence,  he  paid  little  attention 
to  the  circumstance.  His  urine  was  constantly  muddy ;  it  was  passed  slowly, 
and  with  difl&culty,  and  threw  down  large  quantities  of  thick  and  flocculent 
deposit. 

M.  De  B.  awaited  the  period  of  his  marriage  with  a  vague  uneasiness,  of 
which  he  could  not  imagine  the  cause ;  he  was  much  attached  to  his  be- 
trothed, but,  nevertheless,  he  experienced  more  embarrassment  than  pleasure 
in  her  society. 

I  have  already  stated  what  occurred  after  his  marriage ;  I  should  add, 
that  having  examined  the  genital  organs,  I  found  them,  contrary  to  my  ex- 
pectations, of  unusual  development,  the  testicles  were  large  and  firm,  but 
the  scrotum  was  slightly  relaxed.  The  patient  experienced  a  strange  ting- 
ling in  the  organs,  and  at  times  felt  as  if  they  were  compressed  by  a  hand 
of  iron.  These  sensations  increased  when  near  his  wife,  and  the  penis  di- 
minished in  size,  and  became  retracted  towards  the  pubes,  in  proportion  as 
he  endeavored  to  excite  erection. 

The  union  of  all  these  circumstances  could  not  permit  any  doubt  to  remain 
on  my  mind  as  to  the  nature  of  his  disease ;  it  became  evident  that  all  idea 
of  cerebral  affection  must  be  abandoned,  and  that  the  diurnal  pollutions  with 
all  the  symptoms  of  which  they  were  the  cause,  must  be  referred  to  the 
patient's  constipation. 

The  first  indication  to  be  fulfilled,  therefore,  was  to  relieve  the  constipa- 
tion ;  indeed  I  hoped  this  was  all  that  would  be  necessary ;  the  youth  of 
the  patient,  the  development  of  the  genital  organs,  and  the  strength  of  his 
constitution  induced  me  to  suppose  that  his  cure  would  be  prompt  and  easy. 
Things  did  not,  however,  follow  so  simple  a  course.  •> 

The  next  day  the  patient  began  to  use  ascending  douches;  and  was  put 
on  a  vegetable  diet,  with  iced  milk. 

The  first  douches  caused  the  evacuation  of  an  immense  quantity  of  fecal 
matter  in  lumps,  as  hard  as  bullets,  and  it  was  not  until  after  the  sixth 
douche  that  the  feces  were  of  normal  consistence ;  I  then  caused  the  tem- 
perature of  the  water  to  be  lowered  to  25°  of  Reaumur's^  scale,  and  after- 

»  About  88°  of  Fahrenheit. 


INFLUENCE    OF    THE    EECTUM.  103 

wards  to  20°  Reaumur.*  The  last  douches  were  given  at  16°  Reaumur.^ 
After  the  twelfth  douche  had  been  administered,  they  were  omitted,  the 
bowels  having  acted  regularly  every  day,  without  the  necessity  for  the  slight- 
est straining. 

By  this  time  the  patient's  countenance  had  lost  its  purple  tint,  and  pre- 
sented a  more  natural  appearance  ;  the  stunning  sensations  of  which  he  had 
complained  diminished  by  degrees,  and  at  length  disappeared  entirely ;  his 
legs  regained  their  strength,  and  he  was  able  to  continue  in  a  standing  pos- 
ture for  a  long  time  without  fatigue,  and  to  take  long  walks  without  incon- 
venience ;  his  voice  resumed  its  natural  tone,  his  eye  regained  its  expression, 
and  all  his  motions  acquired  firmness. 

At  the  expiration  of  a  fortnight  the  spermatic  discharges  during  defecation 
had  ceased  entirely ;  but  his  urine  still  continued  thick.  His  erections  had 
already  acquired  sufficient  energy  to  make  him  believe  himself  cured,  but 
ejaculation  took  place  almost  instantaneously.  The  use  of  ice  and  cold  lotions 
did  not  ameliorate  his  condition.         • 

Such  was  M.  De  B 's  state  at  the  end  of  a  month  ;  when,  in  order  to 

act  directly  on  the  orifices  of  the  ejaculatory  ducts,  I  determined  to  cauterize 
the  prostatic  portion  of  the  urethra.  As  soon  as  the  inflammation  had  sub- 
sided, his  erections  became  more  perfect  and  energetic;  yet  ejaculation  still 
took  place  too  rapidly.     The  period  for  using  the  mineral  waters  having 

arrived,  I  sent  M.  De  B to  Aix,  in  Savoy,  where  I  visited  him  shortly 

after.  He  had  experienced  very  little  benefit  from  the  use  of  the  waters, 
either  externally  or  internally. 

I  now  prescribed  douches,  alternately  very  warm  and  very  cold,  on  the 
perineum  and  loins,  the  spout  being  changed  when  the  sensation,  either  of 
cold  or  heat,  became  very  intense.  The  bath  was  ended,  after  about  twenty 
or  twenty-five  minutes,  by  the  cold  douche,  and  the  patient's  skin  remained 
highly  injected  for  some  hours  afterwards. 

The  effects  of  these  douches  were  conclusive;  after  the  first,  the  patient's 
erections  acquired  a  degree  of  vigor  and  duration  which  reminded  him  of 
his  early  torments.  He  continued  the  use  of  the  douches  for  some  days 
after  his  re-establishment ;  and  when  he  left  Aix  the  functions  of  his  genital 
organs  were  perfect.  Ejaculation  was  a  good  deal  protracted  by  the  use  of 
the  douches. 

I  have  entered  into  a  somewhat  lengthy  detail  of  this  case,  because 
the  subject  affects  gravely  the  most  serious  interests  of  society,  as 
well  as  the  happiness  and  peace  of  families.  Besides  I  confess  that 
I  was  much  interested  by  the  unhappy  position  of  a  young  man  whose 
misfortune  was  undeserved,  and  could  not  have  been  foreseen,  as  well 
as  by  that  of  his  wife — a  young  woman  scarcely  of  age,  who  was 
obliged  to  enter  into  the  most  unpleasant  details. 

It  is  evident  that  in  the  case  of  M.  De  B ,  the  constipation  was 

the  cause  of  the  involuntary  seminal  discharges.  The  patient  had 
practised  masturbation  it  is  true,  and  nocturnal  emissions  followed  ; 
but  he  had  continued  the  vice  only  three  months,  and  his  health, 


»  About  81°  of  Fahrenheit.  '  About  68°  of  Fahrenheit. 


104  CAUSES    OF    SPEEMATOEKHCEA. 

though  disordered  for  a  short  time,  was  soon  re-established  by  the  use 

of  violent  exercise.     M.  De  B was  even  tormented  during  several 

years  by  erections  which  must  have  been  very  energetic,  if  we  may 
]udge  by  the  means  he  took  to  subdue  them.  From  this  time  he  had 
never  committed  any  kind  of  excess,  and  he  had  never  suffered  from 
either  blennorrhagia  or  syphilis.  There  is  then  no  circumstance  in 
the  history  of  his  life,  except  his  constipation,  which  would  account 
for  the  involuntary  discharges. 

But  to  what  is  this  constipation  to  be  referred  ?  After  all  I  could 
learn  from  the  patient  concerning  his  mode  of  life,  I  could  only  refer 

it  to  his  constant  horse  exercise.     In  fact,  M.  De  B sometimes 

passed  whole  days  on  horseback,  either  for  the  purpose  of  hunting, 
or  of  superintending  the  management  of  his  property.  Shortly 
before  his  marriage  his  rides  became  more  frequent  and  longer,  and 
his  bowels  at  this  time  did  not  act'during  forty  days.  The  weakness 
of  his  legs,  the  stunning  sensations,  &c.,  increased  in  proportion  as 
his  costiveness  became  more  confirmed. 

This  case  recalls  to  my  mind  the  well  known  observation  of  Hip- 
pocrates on  the  impotence  of  the  Scythians,  and  I  have  no  doubt 
that  his  opinion  was  founded  on  analogous  facts.  I  shall  treat  this 
subject  more  fully  in  another  place ;  but  since  at  present  I  am  con- 
sidering the  causes  of  spermatorrhoea  which  act  on  the  seminal 
vesicles  through  the  influence  of  the  rectum,  I  report  this  striking 
case,  showing  the  effects  of  long  continued  horse  exercise. 

M.  De  B was  accustomed  to  nutritious  food,  and  of  a  well 

marked  sanguineous  temperament ;  he  had  a  large  chest,  powerful 
muscles,  and  a  highly  injected  countenance ;  it  is  therefore  by  no 
means  extraordinary  that  he  should  have  'been  bled  frequently  for 
the  relief  of  the  cerebral  congestions  to  which  he  was  subject.  On 
the  night  of  his  marriage  the  blood  rushed  to  bis  head  with  greater 
force  than  ever,  so  that  an  attack  of  apoplexy  was  much  feared  ;  the 
weakness  of  the  legs,  the  frequent  falls,  and  the  attacks  of  vertigo, 
were  therefore  afterwards  attributed  to  an  advanced  stage  of  disease 
of  the  brain.  This  was  a  very  natural  opinion,  but  it  was  an  incor- 
rect one ;  I  doubted  it  from  the  commencement,  although  the  patient 
was  brought  to  me  in  consequence  of  a  supposed  cerebral  affection. 
I  formed  a  different  impression,  because  I  had  previously  seen  many 
analogous  cases.  There  exists  in  all  these  patients  something  pe- 
culiar in  the  expression  of  the  eyes,  in  the  position,  in  the  voice, 
and  in  the  general  appearance ;  something  of  timidity  and  bashful- 
ness  which  I  am  unable  to  express,  but  which  is  instantly  recognized 
by  the  experienced,  although  perhaps  it  is  incapable  of  explanation. 
However  this  may  be,  the  relation  of  the  above  case  should  draw 
attention  to  the  subject. 

I  admit  that  venesections  s^f-mec?  to  be  clearly  indicated  in  the  case 

of  M.  De  B ,  but  the  loss  of  blood  never  produced  good  effects, 

either  immediate  or  remote ;  and  by  analyzing  the  case  carefully  his 
attendants  would  have  seen  that  under  this  treatment  the  attacks  in- 


INFLUENCE    OF    THE    EECTUM.  105 

creased  in  frequency.  But  pre-convictions  throw  a  thick  veil  over 
the  most  acute  perceptions. 

The  ascending  douches  put  an  end  to  the  constipation  ;  but  free- 
dom of  fecal  evacuation  did  not  suffice  to  cure  the  disease.  The 
seminal  discharges,  during  the  passage  of  feces,  diminished,  indeed, 
or,  perhaps,  entirely  ceased,  but  the  patient's  urine  remained  thick 
and  muddy,  and  his  erections  were  incomplete.  The  application  of 
ice  and  of  the  nitrate  of  silver,  and  the  use  of  sulphureous  waters 
.were  not  sufficient  to  effect  his  cure;  yet  there  could  not  have  ex- 
isted any  organic  change  in  his  genital  organs.  We  can  therefore 
only  attribute  the  continuance  of  the  seminal  discharge,  during  the 
emptying  of  the  bladder,  to  relaxation  of  the  ejaculatory  canals, 
produced  by  their  long  habit  of  allowing  the  semen  to  escape  in  a 
passive  manner — showing  how  necessary  it  is  to  put  an  end  to  the 
habit  as  early  as  possible. 

The  alternate  use  of  hot  and  cold  douches  on  the  loins  and  perineum 
produced  a  sudden  and  decisive  change  in  this  as  in  many  analogous 
cases  ;  I  shall  therefore  return  to  their  consideration  by  and  by.  At 
present  I  must  only  remark,  that  they  should  never  be  employed  so 
long  as  any  irritation  of  the  genital  organs  exists,  as  under  such  cir- 
cumstances they  produce  the  most  unfavorable  effects, 

CASE  XX. 

Lengthened  exposure  to  severe  cold — Incomplete  paralysis  of  the  rectum — 
Seminal  discharges  during  defecation — Cure  hi/  the  application  of  gal- 
vanism. 

M.  V ,  aged  twenty-nine,  a  captain  in  an  infantry  regiment,  had  suf- 
fered from  five  to  six  attacks  of  blennorrhagia,  and  afterwards  from  a  chancre, 
for  the  cure  of  which  he  took  a  considerable  quantity  of  the  bichloride  of 
mercury.  At  the  end  of  the  treatment,  in  1822,  he  left  Metz,  to  go  to 
Spain.  During  his  journey  he  was  detained  three  weeks  at  Lyons,  in  con- 
sequence of  a  disorder  of  which  the  most  prominent  symptom  was  obstinate 
costiveness  accompanied  by  fever.  During  the  remainder  of  his  journey  he 
was  obliged,  for  the  first  time,  to  support  his  left  testicle,  the  veins  of  which 
were  varicose.  During  the  whole  campaign  he  did  not  suffer  from  any  other 
disease  except  occasional  haemorrhoids. 

After  having  endured  the  fatigues  of  war  without  disorder,  M.  V , 

whilst  returning  to  France,  was  exposed  during  an  entire  night  to  ex- 
treme cold,  being  at  the  same  time  very  lightly  clothed.  The  next  day  he 
felt  acute  and  darting  pains  in  his  legs,  and  these  were  soon  followed  by  a 
feeling  of  cold,  referred  chiefly  to  the  under  part  of  the  left  hip-joint,  and 
to  the  hypogastrium. 

From  this  period  a  new  train  of  symptoms  appeared.  The  patient  felt 
his  legs  daily  becoming  weaker  j  he  was  subject  to  obstinate  constipation. 
It  seemed  to  him  as  if  the  powers  intended  for  the  expulsion  of  the  feces 
were  paralyzed;  and  he  experienced,  moreover,  in  the  distended  intestine, 
a  feeling  of  elastic  reaction,  rather  than  one  of  muscular  contraction. 
Abundant  seminal  discharges  attended  his  efforts  at  stool.     Agitation  gene- 


106  CAUSES    OF    SPERMATORRHCEA. 

rally  followed  the  evacuation  of  any  feces.  The  venereal  impulse  was  nearly 
lost,  erections  occurred  seldom,  and  were  incomplete,  and  coitus  was  im- 
possible, except  under  very  extraordinary  circumstances,  and  very  rarely. 
The  patient's  digestion  became  difficult ;  flatus  accumulated  in  the  intes- 
tines distended  his  abdomen,  and  caused  pain  in  his  epigastric  and  hypo- 
chondriac regions;  his  skin  became  habitually  dry  and  harsh.  He  wished 
to  take  exercise  to  favor  cutaneous  transpii-ation,  and  was  in  a  continued 
state  of  agitation  as  soon  as  he  remained  still  for  a  few  minutes ;  he  was 
easily  affected  by  cold,  and  his  temper  became  very  irritable. 

The  suspensory  bandage  he  wore  inconvenienced  him,  and  he  left  it  off 
before  taking  a  long  walk.  Shortly  after  his  return,  a  considerable  swelling 
came  on  in  the  left  testicle,  to  disperse  which  leeches  were  applied  five  times 
unsuccessfully. 

About  this  time  bichloride  of  mercury  was  administered  in  solution  for 
the  treatment  of  some  supposed  venereal  vegetations  around  the  margin  of 
the  anus,  but  which,  in  reality,  were  only  contracted  haemorrhoids.  The 
different  means  pursued  increased',  to  a  great  degree,  the  patient's  weak- 
ness of  the  legs  and  digestive  disorder. 

"When  Captain  V came  to  the  hospital  of  St.  Eloi,  I  was  struck  by 

the  pallidity  of  his  countenance,  and  the  flaccidity  of  all  his  tissues.  His 
form  was  rounded,  with  the  cellular  tissue  very  abundant  and  slightly  infil- 
trated with  serum,  especially  in  his  legs ;  his  skin  was  white,  thin,  trans- 
parent, and  habitually  cold;  his  pulse  small  and  feeble.  The  tumor  of 
the  left  testicle  was  evidently  only  a  common  hydrocele. 

Taking  into  consideration  the  order  of  appearance,  and  the  general  charac- 
ter of  the  symptoms,  I  thought  that  the  intense  and  lengthened  action  of 
cold  had  produced  a  deep  and  lasting  effect  on  the  inferior  portion  of  the 
spinal  cord,  as  I  had  before  seen  in  a  few  cases.  Weakness  seemed  to  me  to 
be  the  symptom  predominating,  no  appearance  of  irritation  being  present, 
either  in  the  rectum  or  the  genito-uniary  organs;  and  I  consequently 
decided  on  submitting  the  affected  parts  to  the  action  of  galvanism. 

The  first  sitting  took  place  on  the  11th  of  February.  The  current  was 
established,  during  twenty  minutes,  between  the  sacrum  and  hypogastrium  ; 
and  afterwards,  for  the  same  period,  between  the  hips.  The  shocks  were 
very  weak,  only  sixteen  drops  of  sulphuric  acid  having  been  added  to  the 
quart  of  water ;  yet,  on  the  following  day,  the  patient  experienced  less  sen- 
sation of  cold,  less  numbness  in  his  left  leg  and  in  his  genital  organs,  and 
less  difficulty  in  emptying  his  bladder ;  besides  which  he  had  a  stool. 

On  the  12th  a  second  sitting  took  place.  The  shocks  were  directed 
through  the  same  parts,  and  applied  during  the  same  length  of  time ;  eighty 
drops  of  sulphuric  acid  being  used  on  this  occasion. 

On  the  13th  a  third  sitting  was  held,  a  hundred  drops  of  acid  being  used. 
Stronger  shocks  were  administered.  Impressions  were  now  more  acutely 
felt,  and  the  patient's  improvement  seemed  progressively  increasing. 

On  the  14th,  galvanism  was  again  applied,  a  hundred  and  forty  drops  of 
sulphuric  acid  being  added  to  the  quart  of  water.  The  current  was  esta- 
blished occasionally  between  the  loins  and  the  perineum,  and  the  surface  of 
the  hydrocele.  The  following  day  the  patient  had  a  free  evacuation  with- 
out enema;  he  experienced  a  feeling  of  power  in  the  rectum,  with  less 
numbness  in  the  lower  extremities,  from  the  pelvis  as  far  as  the  knees ;  the 
legs  and  feet  were  in  the  same  state  as  before ;  there  was  a  considerable 
diminution  in  the  size  of  the  hydrocele;  the  patient's  erections  had  become 


INFLUENCE    OF   THE    EECTUM.  107 

more  energetic,  and  he  was  altogether  more  cheerful,  notwithstanding  the 
fatigue  caused  him  by  the  -violent  shocks  to  which  he  had  been  subjected. 
He  spoke  of  the  galvanism  with  pleasure,  but  requested  two  or  three  days' 
rest  before  being  again  subjected  to  its  action. 

From  the  15th  to  the  19th  galvanism  was  not  employed.  No  improve- 
ment took  place  during  these  days. 

From  the  20th  to  the  24th  five  sittings  similar  to  the  preceding  took 
place,  the  quantity  of  sulphuric  acid  being  increased  on  each  occasion.  Af- 
ter these  the  bowels  were  opened  freely  every  day,  without  straining  or 
seminal  discharge.  His  ui'ine  was  discharged  easily,  in  a  full  stream.  The 
liquid  effused  in  the  tunica  vaginalis  was  completely  absorbed.  The  pa- 
tient's digestion  became  active;  the  intestinal  flatulence  disappeared,  and  the 
warmth  and  strength  of  the  inferior  extremities  were  restored. 

Shortly  afterwards  M.  V rejoined  his  regiment,  and  resumed  his 

duties  as  before.     Four  or  five  years  afterwards  I  met  with  M.  V ,  who 

had  attained  the  rank  of  general.  He  told  me  that  his  health  had  not  un- 
dergone the  least  alteration. 

This  patient  had  suffered  from  five  or  six  attacks  of  urethritis, 
besides  a  chancre,  and  he  had  undergone  many  energetic  courses  of 
anti-venereals,  of  which  one  course  only  would  have  been  useless, 
and  even  injurious.  There  are,  therefore,  many  reasons  why  his 
case  should  have  been  placed  among  those  of  which  I  have  treated  in 
the  third  chapter.  On  the  other  hand,  he  had  suffered  for  a  long 
time  from  haemorrhoids,  which  were  on  one  occasion  even  mistaken 
for  syphilitic  vegetations,  a  mistake  by  no  means  uncommon.  The 
seminal  discharges  were,  however,  due  to  the  distension  of  the  rec- 
tum (as  in  case  ifourteen),  yet  it  seems  probable  that  the  other  circum- 
stances had  some  share  in  bringing  on  the  disease,  because  Captain 

V had  suffered  from  obstinate   constipation  when  at  Lyons. 

These  circumstances  must,  therefore,  be  taken  into  account ;  but  the 
determining  cause  was,  evidently,  the  extreme  cold  to  which  he  was 
exposed  during  the  whole  night.  This  gave  the  disease  a  peculiar 
character,  which  is  not  otherwise  met  with. 

The  first  time  I  saw  this  patient,  I  attributed  the  weakness  of  his 
lower  extremities,  his  constipation,  &c.,  to  the  seminal  discharges  ; 
but  on  more  mature  reflection  respecting  the  sudden  effect  of  this 
lengthened  exposure  to  cold,  I  recollected  other  cases  of  the  same 
nature,  in  which  cold  had  left  a  serious  impression  of  debility  in  the 
parts  which  had  chiefly  suffered.  I  was  struck  by  the  general  and 
truly  characteristic  state  of  the  constitution,  by  the  infiltration  with 
serum  of  the  affected  parts,  by  the  temperature  of  the  skin,  &c. ;  I 
concluded,  therefore,  that  the  pollutions  arose  from  distension  of  the 
rectum,  and  that  this  was  kept  up  by  a  kind  of  torpidity  which  the 
cold  had  produced  in  the  nerves  arising  from  the  inferior  portion  of 
the  spinal  cord.  This  chain  of  reasoning  led  me  to  think  of  gal- 
vanism— a  remedy  from  the  use  of  which  I  had  seen  benefit  arise  in 
analogous  cases. 

The  result  proved  this  indication  to  be  the  right  one,  and  the  cure 
was  even  more  rapid  and  decided  than  I  had  ventured  to  hope  for. 


108  CAUSES    OF    SPEEMATOERH(EA. 

The  hydrocele  which  existed  in  this  pcatient  seemed  to  have  been 
caused  by  the  repeated  attacks  of  urethritis ;  and  the  rapidity  with 
which  the  eifusion  was  absorbed  under  the  use  of  galvanism,  was 
very  remarkable.  This  circumstance  proves  galvanism  to  have  been 
the  remedy  best  suited  to  the  case.  I  shall  relate  here  another  case, 
illustratino-  the  eifects  of  cold,  and  which  is  also  remarkable  in  other 
respects. 

CASE  XXI. 

Intemperance — LengtJiened  exposure  to  cold — Chronic  inflammation  of  the 
bladder — Invohuitary  seminal  discharges,  cCr. —  Cauterization — Cxire — 
Relapse — Same  treatment  loith  the  same  result — Remarkable  influence  of 
the  bladder  on  the  rectum. 

G ,  a  soldier  in  the  4th  regiment  of  light  infantry,  much  addicted  to 

intemperance,  enjoyed  pretty  good  health,  with  the  exception  of  two  or 
three  slight  attacks  of  blennorrhagia,  until  the  age  of  thirty.     At  this  age, 

however,  when  intoxicated  and  in  an  excessive  state  of  perspiration,  G 

plunged  into  cold  water  as  far  as  his  middle,  and  afterwards  allowed  his 
clothes  to  dry  on  his  person. 

Shortly  afterwards  G felt  acute  pain  in  the  lumbar  region,  with  weight 

in  the  hypogastrium,  and  a  frequent  desire  to  make  water,  which  he  passed 
with  some  little  diflBculty.     Camphorated  frictions  on  the  loins,  with  rest, 

and  an  antiphlogistic  regimen,  gave  him  momentary  relief;  but  G- soon 

perceived  that  he  was  more  easily  fatigued  than  before,  and  especially  that 
his  legs  daily  grew  weaker.  He  continued  to  perform  his  military  duties 
during  eigliteen  months,  though  with  great  and  increasing  difSculty ;  and  at 
length  he  became  so  weak  that  he  was  obliged  to  apply  for  his  discharge. 

Having  returned  to  his  native  town,  he  commenced  business  as  a  tailor, 
and  he  had  not  long  followed  this  employment  when  he  perceived  that  he 
passed  semen  frequently,  without  either  erection  or  pleasure.  These  dis 
charges  grew  more  and  more  frequent,  and  were  accompanied  by  an  irresisti- 
ble and  frequent  call  to  empty  the  rectum  ;  his  urine  was  passed  with  much 
difficulty,  requiring  efforts  which  were  very  fatiguing. 

During  the  years  1830  and  1881,  the  weakness  of  his  legs  continued  to 
increase.  His  digestion  was  difficult,  and  his  genital  organs  were  much 
relaxed. 

In  March,  1832,  after  a  fit  of  intemperance,  G was  seized  by  a  com- 
plete retention  of  urine,  for  which  baths,  fomentations,  and  emollient  drinks 
were  prescribed.  This  state  gave  place  to  one  of  strangury,  soon  followed 
by  incontinence  of  urine. 

In  May,  1832,  artificial  sulphuretted  baths  were  employed  without  bene- 
fit, and  in  September,  the  baths  of  Balaruc,  with  no  better  result. 

On  the  4th  of  October,  G was  admitted  into  the  hospital  of  St.  Eloi. 

Two  moxas  were  applied  to  his  loins,  and  shortly  afterwards  four  i.ssues 
lower  down. 

On  the  1st  of  November,  G took  some  soup  and  wine,  and  the  fol- 
lowing day  acute  irritation  of  the  neck  of  the  bladder  came  on,  for  which 
he  was  treated  by  leeches  to  the  hypogastrium,  baths  and  camphorated 
drinks.  The  pain  diminished,  but  the  passage  of  urine  was  preceded  by  a 
discharge  of  milky  fluid. 


INFLUENCE  OF  THE  EECTUM.  109 

At  this  time  the  patient  first  came  under  my  care.  I  found  him  in  the 
following  state.  He  was  thirty-five  years  of  age,  of  moderate  stature ;  his 
skin  white,  face  pale,  hair  black  and  scanty,  voice  feeble  and  rather  husky, 
digestion  difficult,  especially  after  the  use  of  animal  food ;  he  was  frequently 
compelled  to  go  to  stool,  the  presence  of  a  little  fecal  matter  in  the  rectum 
inducing  a  painful  feeling,  which  caused  its  involuntary  expulsion.  lie 
passed  urine  every  ten  minutes  or  quarter  of  an  hour,  without  being  aware 
of  its  escape,  and  the  fluid  contained  an  abundant  deposit  of  a  greenish-white 
color,  which  appeared  flocculent.  The  urine  decomposed  very  rapidly.  He 
had  no  venereal  desires,  and  not  the  least  appearance  of  erections.  His  lower 
extremities  were  so  weak  as  scarcely  to  support  the  weight  of  his  body.  His 
legs  were  the  constant  seat  of  osseous  pains,  and  his  feet  were  habitually 
cold.     He  seemed  indifferent  to  everything. 

On  the  14th  of  November  I  performed  a  slight  cauterization  of  the  neck 
of  the  bladder,  and  of  the  surface  of  the  prostate.  The  patient  experienced 
little  pain  during  the  operation  ;  there  was  no  discharge  of  blood  and  but 
little  burning  afterwards. 

On  the  2'2d  the  urinary  deposit  had  considerably  decreased  in  quantity. 

By  the  26th  the  deposit  had  entirely  disappeared. 

On  the  28th  the  urine  appeared  quite  limpid,  and  the  patient  was  able  to 
retain  it  for  half  an  hour,  but  it  was  still  passed  involuntarily.  The  feces 
were  not  passed  so  often,  and  the  lower  extremities  were  a  little  stronger. 

Ou  the  29th  I  performed  a  second  and  more  complete  cauterization  of  the 
same  parts.  The  pain  was  considerable,  and  followed  by  burning.  Bloody 
urine  was  afterwards  passed  very  frequently.  On  the  4th  of  December 
the  patient  was  able  to  walk  without  the  aid  of  crutches ;  his  appetite  and 
his  spirits  returned.  On  the  following  days  the  urine  and  feces  were  held 
longer. 

On  the  11th  of  December  a  third  cauterization  was  practised,  beginning 
by  the  bladder,  and  ending  at  the  bulb  of  the  urethra. 

On  the  18th  the  patient  was  able  to  retain  his  urine,  which  was  quite 
limpid,  for  an  hour;  animal  food  was  well  digested;  his  erections  returned; 
his  legs  regained  their  normal  strength ;  his  face  acquired  color  and  ani- 
mation, and  his  spirits  had  returned.  The  feces,  were  retained  as  long  as  in 
health. 

On  the  20th  the  patient  felt  so  well  that  he  left  the  hospital ;  his  con- 
valescence continued,  and  indeed,  seemed  to  make  more  rapid  progress  in 
proportion  to  the  amount  of  exercise  he  took. 

In  the  month  of  February,  1833,  G having  occasion  to  take  a  long 

journey  during  very  severe  cold,  drank  a  considerable  quantity  of  wine. 
In  the  month  of  May  he  re-entered  the  hospital,  in  almost  the  same  state  as 
at  first.  I  performed  a  fourth  cauterization  similar  to  the  last  and  with  the 
same  good  effects. 

I  afterwards  prescribed  tar-water  and  the  use  of  artificial  sulphuretted 
baths,  and  at  the  end  of  two  months  all  the  symptoms  had  disappeared,  and 
the  patient  left  the  hospital  quite  re-established. 

A  lengthened  exposure  to  cold  was  followed  in  this,  as  in  the  pre- 
vious case,  by  diurnal  pollutions,  and  bj  almost  complete  paralysis 
of  the  lower  extremities.  But  here  all  resemblance  between  the  two 
cases  ceases. 


110  CAUSES    OF    SPERMATOERHCEA. 

In  Captain  V the  cold  had  acted  especially  on  the  nerves 

which  are  given  off  by  the  lower  portion  of  the  spinal  cord  ;  these 
had  been  affected  with  a  loss  of  power,  from  which  the  rectum  had 
chiefly  suffered :  hence,  its  distension  by  feces,  and  the  consequent 
compression  of  the  seminal  vesicles.  There  was  not  the  slightest 
appearance  of  irritation  in  the  parts,  and,  for  this  reason,  the  gal- 
vanism produced  such  beneficial  effects.     In  the  patient  G ,  the 

cold  chiefly  acted  on  the  bladder,  and  the  chronic  cistitis  resulting 
from  it  extended  its  influence  successively  to  the  seminal  vesicles  and 
the  rectum.  The  extreme  weakness  of  the  lower  limbs  arose  from 
the  repeated  seminal  discharges,  which  wore  the  patient  out.  Hence 
cauterization  was  followed  by  the  happiest  results.  I  am  convinced 
that  in  this  case  galvanism  could  not  have  been  borne. 

It  is  easy  to  explain  why,  in  the  latter  case,  cold  acted  so  directly 
on  the  bladder — the  patient's  intemperance  predisposed  that  organ 

to  disease.     G was  intoxicated  when  he  went  into  the  water ; 

afterwards,  when  he  experienced  a  rapid  increase  of  his  bad  symp- 
toms, he  had  taken  wine  with  his  soup ;  and  still  later,  in  the  jour- 
ney during  the  winter,  which  was  the  cause  of  his  relapse,  he  had 
drunk  a  considerable  quantity  of  wine.  It  is,  therefore,  by  no  means 
easy  to  separate  the  effects  of  cold,  in  this  case,  from  those  of  intem- 
perance, the  action  of  which  on  the  urinary  organs  is  easily  explained. 
When  considering  the  effects  of  blennorrhagia,  I  reported  a  case  in 
which  cold  exercised  a  considerable  influence  in  the  production  of 
spermatorrhoea  (case  fifth),  but  this  effect  was  shown  by  very  differ- 
ent symptoms.  Strangely  enough,  the  treatment  which  cured  these 
three  patients  was  quite  different  in  each  case — showing  the  indis- 
pensable necessity  of  observed  numerous  cases,  and  of  examining 
minutely  all  their  peculiarities. 

A  phenomenon  was  present  in  the  case  of  the  patient  G ,  which 

shows  that  the  influence  of  the  rectum  on  the  genito-urinary  organs 
is  quite  equalled  by  that  of  the  genito-urinary  organs  on  the  rectum. 
The  mucous  membrane  of  the  intestine  was  in  this  case  so  irritable 
that  the  gut  was  unable  to  bear  the  presence  of  fecal  matter ;  imme- 
diately that  the  feces  reached  the  level  of  the  bladder,  convulsive 
contractions  of  the  muscular  coat  of  the  rectum  were  excited,  causing 
their  immediate  and  involuntary  expulsion.  The  stools  were  not 
liquid,  or  mixed  with  mucus,  as  in  diarrhoea,  though,  in  consequence 
of  their  short  stay  in  the  rectum,  they  were  by  no  means  solid. 

No  particular  treatment  was  pursued  for  the  removal  of  the  irri- 
tation of  the  rectum ;  it  diminished  after  each  cauterization,  and  dis- 
appeared at  the  same  time  as  the  inflammation  of  the  bladder.  The 
longer  the  patient  was  able  to  hold  his  urine,  the  less  frequent  his 
stools  became ;  and  both  bladder  and  rectum  seemed  to  return  under 
the  influence  of  the  will  at  the  same  time. 

But  if  the  inflammation  of  the  bladder  could  produce  such  an  effect 
on  the  rectum,  it  must  have  acted  with  still  greater  power  on  the 
seminal  vesicles.     What,  then,  was  the  cause  of  the  patient's  expe- 


INFLUENCE    OF    THE    RECTUM.  Ill 

riencing  constant  discharges  of  semen,  both  by  clay  and  night,  with- 
out erection,  without  pleasure,  and  in  the  midst  of  the  most  perfect 
repose  as  regarded  venereal  excitement?  A  certain  quantity  of  the 
spermatic  fluid  having  reached  the  seminal  vesicles,  produced  in  them, 
by  its  mere  presence,  involuntary  and  irresistible  spasmodic  contrac- 
tions, similar  to  those  of  the  bladder  and  rectum  ;  the  semen  was 
expelled  in  the  same  manner  as  the  urine  and  the  feces,  and  with- 
out the  characters  which  it  would  have  acquired  after  a  longer  de- 
tention in  the  reservoirs  destined  for  its  reception. 

It  is  evident,  then,  that  an  intimate  relationship  exists  between  all 
these  parts,  and  that  it  is  necessary  to  connect  their  phenomena  in 
order  to  obtain  a  correct  and  perfect  idea  of  their  influence. 

It  must  by  no  means  be  thought  that  this  effect  of  the  genito-uri- 
nary  organs  on  the  rectum  is  of  rare  occurrence ;  it  is,  on  the  con- 
trary habitual ;  but  it  is  seldom  so  strikingly  shown  as  in  the  pre- 
ceding case.  I  have  not  hitherto  noticed  it,  because  I  wished  to 
render  the  subject  as  simple  as  possible ;  but  it  is  to  this  intimate 
connection  that  the  sensation  of  uneasiness  and  weicrht  at  the  margin 
of  the  anus,  the  habitual  contraction  of  the  sphincter,  and  the  ob- 
stinate constipation,  which  are  so  often  observed  in  patients  affected 
by  spermatorrhoea,  must  be  attributed.  All  those  on  whom  I  have 
practised  cauterization  of  the  neck  of  the  bladder,  have  experienced 
a  sudden  burning  at  the  margin  of  the  anus,  and  a  sensation  of  heat 
in  the  rectum  immediately  after  the  operation  ;  on  the  following  day 
they  have  had  greater  tone  in  the  rectum,  and  their  stools  have 
very  soon  become  more  free.  I  must  not,  however,  at  present  enter 
into  further  details  on  this  subject. 

CASE  XXII. 

Unsuspected  sperviatoi'vhoea — Attacks  of  cerebral  congestion — Disorder  of 
the  general  health — Ascarides  expelled  from  the  rectum  with  immediate 
recovery, 

M.  C ,  a  Captain   of  Engineers,  aged  about  thirty-two,  nearly  bald, 

very  thin  and  pale,  with  sunken  eyes  surrounded  by  dark  circles,  a  feeble, 
shrill  voice,  and  a  timid,  embarrassed  appearance,  consulted  me  respecting 
bis  health  on  several  occasions  :  I  never  attached  much  importance  to  his 
complaints,  but  always  attributed  them  to  the  melancholy  bias  of  his  cha- 
racter. In  1824,  however,  his  digestion  became  disordered  in  an  alarming 
manner,  and  was  always  accompanied  by  the  disengagement  of  much  fla- 
tus; even  the  ingestion  of  soup  into  the  stomach  was  followed  by  oppres- 
sion in  the  epigastric  region,  and  diiEculty  of  respiration,  which  was.  espe- 
cially felt  in  the  situation  of  the  oesophagus,  and  terminated  in  the  pharynx. 
This  sensation  diminished  considerably  as  soon  as  the  patient  was  able  to 
pass  flatus.  He  felt  himself  overcome  by  a  sense  of  general  debility,  and 
especially  experienced  a  feeling  of  weakness  in  his  legs,  which  contrasted 
strikingly  with  his  continual  desire  for  motion,  and  his  custom  of  taking 
long  walks.  He  sufi"ered  from  frequent  attacks  of  giddiness,  with  conges- 
tion in  his  bead,  especially  when  he   stooped,  or  read,  even  for  a  few  mi- 


112  CAUSES    OF    SPERMATOERHCEA. 

nutes,  and  he  consequently  thoup;ht  himself  threatened  by  an  attack  of  apo- 
plexy. His  usual  spareness  of  habit  had  increased ;  his  testicles  had  dimi- 
nished sensibly  in  size,  and  his  genital  organs  always  felt  cold.  His  pulse 
was  weak  and  soft ;  his  tongue  palepnd  moist,  and  pressure  on  the  epigas- 
trium did  not  give  him  the  least  pain.  I  could  not  participate  in  this  patient's 
fears  respecting  the  probability  of  an  attack  of  apoplexy  or  the  existence  of 
gastritis,  for  I  attributed  all  his  symptoms  to  excessive  discharges  of  semen, 
although  he  would  not  admit  the  correctness  of  this  opinion. 

He  iiad  abstained  from  coitus  during  a  long  time,  from  the  fear  of  injuring 
his  health,  and  expressed  a  horror  of  masturbation  :  he  was  not  subject  to 
nocturnal  emission,  and  he  had  never  noticed  any  discharge  of  semen  when 
passing  urine  or  at  stool.  I  sent  him  for  change  of  air  during  the  heat  of 
the  summer,  to  Vigan  in  the  Cevennes,  requesting  him  at  the  same  time  to 
watch  himself  carefully  while  at  stool,  and  to  send  me  an  account  of  the  ap- 
pearance of  his  urine. 

A  few  days  after  his  arrival  at  Vigan  he  sent  me  word  that  after  each 
stool  he  had  a  discharge  of  thick,  whitish,  slightly  unctuous  matter,  of  a  very 
weak  spermatic  odor,  and  which  stained  his  linen  a  pale  yellow.  This 
discharge  was  especially  abundant  whenever  his  efforts  at  stool  were  very 
violent.  It  was  not,  however,  during  the  actual  passage  of  fecal  matter 
that  the  discharges  of  semen  occurred,  but  shortly  afterwards ;  and  he  ex- 
perienced at  the  same  time  a  sense  of  weight  in  the  rectum,  and  a  spasmodic 
contraction  accompanied  by  itching  and  heat.  The  symptoms  were  then, 
as  I  suspected,  really  due  to  excessive  spermatic  discharges.  Yet  I  did  not 
attach  sufl&cient  importance  to  the  singular  circumstances  which  accompa- 
nied these  discharges,  and  I  was  satisfied  when  prescribing  cool  injections, 
cold  lotions,  and  vegetable  and  milk  diet,  with  the  intention  of  relieving  the 
constipation,  and  of  giving  tone  to  the  genital  organs.  These  means  pro- 
dux;ed  no  remarkable  change  in  the  seminal  discharges ;  after  a  time  I  re- 
ceived another  long  letter,  which  was  full  of  minute  and  uninteresting  de- 
tails ;  on  the  back,  however,  the  patient  had  written  a  postscript,  stating 
that  in  one  of  his  stools  he  had  passed  a  number  of  little  worms,  and  that  he 
frequently  felt  an  itching  in  the  rectum,  which  he  attributed  to  a  herpetic 
affection.  A  slight  discharge  occurred  from  the  rectum,  and  the  feces  were 
mixed  with  a  good  deal  of  purulent  mucus.  The  parts  surrounding  the 
anus  were  gorged.  This  state  had  been  present  from  1818,  and  had  first 
appeared  after  a  violent  intestinal  inflammation,  accompanied  with  colic  and 
tenesmus,  which  latter  reappeared  in  1822.  The  cause  of  the  spermator- 
rhoea, now,  was  evident,  and  I  also  understood  how  it  was  that  the  seminal 
discharge  did  not  take  place  exactly  at  the  same  time  as  the  passage  of  the 
feces,  but  a  little  after ;  these  discharges  were  not  produced  by  mechanical 
compression  arising  from  such  passage,  but  they  were  the  result  of  a  state 
of  irritation  produced  by  the  presence  of  worms;  the  sensation  of  pressure, 
the  spasmodic  contraction,  the  itching,  and  the  heat,  which  were  felt  in  the 
rectum,  proved  this. 

The  patient  took,  fasting,  on  three  successive  mornings,  four  grains  of 
calomel,  and  during  the  day  three  or  four  glasses  of  decoction  of  Corsican 
moss,  and  a  tepid  enema,  followed  by  a  cold  one ;  he  once  took  a  small 
enema  of  warm  milk,  and  soon  after  a  second,  composed  of  a  strong  decoc- 
tion of  garlic.  At  the  end  of  three  days,  perceiving  no  more  ascarides  in 
his  stools,  he  left  off  treatment  for  a  week,  after  which  he  took,  at  bedtime, 
four  grains  of  calomel  followed  by  six  drachms  of  sulphate  of  magnesia  the 


INFLUENCE  OF  THE  RECTUM.  113 

next  morning.  Four  copious  stools  were  obtained,  which  presented  no  ap- 
pearance worthy  of  note.      8oon  after  this,  Captain  C wrote  to  me 

stating  that  his  strength  had  returned ;  that  his  stomach  performed  all  its 
functions  properly ;  that  the  spermatic  discharges  had  ceased,  together  with 
the  discharge  from  the  anus,  and  the  itching,  &c.,  with  which  he  had  pre- 
viously been  tormented. 

The  ascarides  reappeared  every  year,  however,  at  a  stated  period,  and 
sometimes  even  twice  a  year,  but  the  patient  was  able  to  treat  himself,  and 
immediately  that  any  symptoms  announced  their  presence,  he  got  rid  of  them 
in  two  or  three  days — his  health  never  becoming  disordered. 


CASE  XXIII. 

Masiurhation  at  nine  years  of  age — Constant  nocturnal  emissions — Ascarides 
—  Cure  in  eight  days. 

Henry  B ,  a  sergeant  of  engineers,  at  the  age  of  nine,  was  addicted 

to  the  vice  of  masturbation,  which  he  continued  to  practise  up  to  the  age  of 
fifteen,  when  he  corrected  himself.  From  this  time  he  experienced  frequent 
nocturnal  pollutions.  Loss  of  flesh  followed,  with  pains  in  the  chest  and  a 
fixed  pain  in  the  middle  of  the  back.  The  whole  nervous  system  was  dis- 
ordered, and  the  patient's  eyes  were  injected  and  surrounded  by  dark  circles. 
After  the  occurrence  of  a  nocturnal  emission,  the  patient  often  noticed  that 
he  had  pricking  sensations,  as  though  he  had  been  stung  by  ants,  with  acute 
pain  in  the  lower  part  of  his  abdomen,  and  in  his  loins. 

He  was  completely  overcome  by  fatigue  in  the  morning,  and  felt,  when 
he  rose  from  bed,  as  though  his  legs  and  arms  had  been  bruised ;  he  com- 
plained also  of  oppression  at  his  chest,  and  a  sense  of  suffocation.  He  felt 
buzzing  in  his  ears  in  the  evening  j  he  lost  his  memory,  was  unable  to  at- 
tend to  his  affairs,  and  performed  his  military  duty  with  much  difficulty.  This 
state  had  continued  for  several  years,  and  became  daily  more  serious. 
Various  modes  of  treatment  had  been  employed  by  different  medical  men 
whom  the  patient  had  consulted;  among  other  remedies  used  may  be 
named  quinine,  oxide  of  iron,  ferruginous  water  mixed  with  wine  of  Bor- 
deaux, lime-water  in  milk,  and  Hoffmann's  anodyne  at  night.  Eiver-bathing 
and  cold  enemata  had  also  been  tried,  and  the  patient  had  applied,  during 
the  coldest  season,  snow  and  ice  over  his  kidneys  and  genital  organs.  No 
advantage  whatever  was  derived  from  all  these  means,  and  sal-ammoniac  dis- 
solved in  water,  to  form  a  cold  lotion,  only  irritated  the  skin  of  the  penis  and 
scrotum. 

Henry  B was  twenty  years  of  age  when  he  first  consulted  me ;  his 

face  appeared  colored  and  healthy,  and  his  form  announced  health  and 
vigor.  It  was  therefore  difficult  to  guess  the  cause  of  the  deep  melancholy 
which  his  features  showed.  After  much  questioning,  I  at  length  learnt  that 
he  had  been  subject  to  worms  from  his  childhood — that  he  passed  them 
every  time  he  went  to  stool,  and  that  his  feces  were  sometimes  quite 
covered  with  them.  From  the  description  he  gave  me,  I  was  convinced 
that  they  consisted  of  oxyures,  with  perhaps  a  few  trichocephali.  I  pre- 
scribed for  him  four  grains  of  calomel  night  and  morning,  with  half  a 
drachm  of  mercurial  ointment  to  be  introduced  into  the  rectum  night  and 
morning,  and  enemata  composed  of  potentilla  anserina  in  decoction.     Eight 


114  CAUSES    OF    SPERMATOEEH(EA. 

days  afterwards  he  told  me  that  his  pollutions  had  ceased,  and  that  his  health 
was  quite  restored. 

CASE  XXIV. 

Hmocliondriasis — Impotence — Attacks  of  cerehral  congestion — Ascarides — 
Cure  within  eight  days. 

A ,  a  gardener  of  large  and  well  formed  frame,  and  dark  complexion, 

two  years  married,  perceived,  seven  or  eight  months  after  marriage,  that 
he  lost  by  degrees  his  virile  power ;  that  his  appetite  at  the  same  time 
became  capricious,  and  his  digestion  difficult  and  accompanied  with  pain 
in  the  epigastrium,  the  development  of  flatus,  and  frequent  attacks  of 
vomiting. 

Pills  containing  cynoglossus,  sedatives,  and  demulcents  of  all  kinds,  had 
been  prescribed  for  this  patient  by  a  distinguished  practitioner  of  Montpel- 
lier,  in  order  to  relieve  the  irritation  of  his  digestive  organs ;  but  his  general 
weakness,  and  that  of  the  genital  organs  in  particular,  increased  daily.  A 
feeling  of  lassitude  constantly  came  over  him,  he  was  habitually  sleepy,  and 
had  frequent  attacks  of  vertigo.  These  symptoms  led  other  practitioners 
whom  he  consulted  to  fear  the  occurrence  of  apoplexy,  and  consequently 
venesection  was  prescribed;  but  the  patient,  notwithstanding  his  uneasi- 
ness, refused  to  be  bled,  saying  that  he  was  convinced  he  had  no  blood  to 
lose.  In  1833,  A consulted  one  of  my  pupils,  who,  after  long  ques- 
tioning, learned  that  he  suffered  from  obstinate  costiveness,  with  troublesome 
itching  in  the  rectum,  and  that  he  frequently  passed  a  number  of  oxyures 
with  his  feces.  Believing  that  these  oxyures  were  the  cause  of  seminal  dis- 
charges which  the  patient  had  not  discovered,  an  infusion  of  mentha  viridis 
was  ordered  for  him,  with  aromatic  enemata,  and  afterwards  enemata  of  cold 
salt  water,  sufficiently  copious  to  distend  the  gut  and  to  be  expelled  with 
some  violence.  These  injections  caused  the  expulsion  of  a  large  number  of 
entozoa. 

The  patient's  digestive  disorder  ceased  almost  immediately;  his  erections 
soon  returned,  and  coitus  took  place  a  few  days  afterwards.  He  soon  re- 
covered his  strength  ;  his  spirits  resumed  their  wonted  gayety,  and  he  recom- 
menced his  work  with  pleasure.  This  change  was  the  result  of  only  eight 
days'  treatment. 

CASE  XXV. 

Nocturnal  pollutions,  resisting  all  modes  of  treatment  during  six  years — 
G7'eat  physical  and  moral  depression — Expulsion  of  ascarides  with  com- 
plete relief. 

M.  D ,  the  son  of  healthy  parents,  at  the  age  of  eleven,  contracted,  of 

his  own  accord,  the  habit  of  masturbation ;  but  he  soon  discovered  its  per- 
nicious effects,  and  corrected  himself;  his  strength  returned,  and  up  to  the 
age  of  fourteen  he  continued  in  perfect  health.  At  this  period,  after  reading 
an  erotic  book,  he  relapsed  into  his  former  habits.  He  also  formed  a  con- 
nection with  a  female,  who  excited  his  passions  without  gratifying  them. 
These  sources  of  excitement  so  enervated  him,  that  palpitation  of  the  heart, 
and  tremors  in  his  limbs,  supervened. 

Up  to  this  period  M.  D had  never  had  an  involuntary  seminal  emis- 


INFLUENCE  OF  THE  KECTUM.  115 

sion,  and  he  still  retained  sufficient  power  over  himself,  only  to  practise 
masturbation  once  a  week.  The  irritation  he  experienced  in  the  genital 
organs  was  so  great  that  he  was  often  forced  to  plunge  them  into  cold  water 
for  its  relief.     He  was  stout  and  tall,  and  his  health  was  robust. 

On  the  25th  of  October,  1815,  on  waking  in  the  morning,  M.  D 

found  that  he  had  experienced  a  copious  seminal  emission  unconsciously 
while  asleep.  On  every  one  of  the  eight  following  nights  he  had  several 
involuntary  emissions.  These  discharges  produced  a  remarkable  state  of 
weakness,  and  he  lost  flesh  visibly ;  still  he  hoped  that  the  discharges  would 
cease  spontaneously,  and  false  delicacy  prevented  him  from  mentioning   his 

state.     Absorbed  in  the  consideration  of  his  own  condition,  M.  D now 

withdrew  himself  from  his  companions,  and  occupied  himself  in  devising 
means  for  the  relief  of  the  discharges.  He  attempted  numerous  ingenious 
contrivances  to  prevent  the  penis  from  becoming  erect  during  sleep,  but  none 
of  them  succeeded;  the  disorder  of  his  health  continued  to  increase,  until  the 
year  1820,  when  his  condition  was  deplorable,  and  he  came  to  Montpellier 
to  place  himself  under  my  care.  From  his  account  of  the  sufferings  he  had 
endured,  I  at  first  thought  that  the  involuntary  emissions  from  which  he  had 
suffered,  arose  from  a  preternatural  sensibility  of  the  genital  organs,  increased 
by  their  premature  use.     Before  commencing  any  plan  of  treatment,  however, 

I  caused  M.  D to  draw  up  a  history  of  his  case,  in  order  that  I  might 

have  all  the  facts  before  me  at  one  view.  While  reading  his  history,  my 
attention  was  arrested  by  the  mention  of  numerous  small  worms,  which  were 
passed  with  the  feces,  and  which  were  looked  on  by  the  unfortunate  patient 
as  a  sign  of  speedy  dissolution.  I  examined  the  anus,  and  was  unable  to 
discover  the  eruption  which  he  mentioned  in  his  memoir,  as  giving  rise  to 
acute  irritation  in  that  neighborhood,  besides  which,  this  eruption  would 
not  have  produced  the  itching  of  the  nose  of  which  he  also  complained.  I 
suspected,  therefore,  that  the  involuntary  emissions  might  be  kept  up  by 
irritation  from  ascarides,  and  I  drew  the  patient's  attention  to  the  circum- 
stance. He  told  me,  immediately,  that  he  passed  them  habitually  in  his 
stools ;  and  that  frequently,  from  the  violent  natui*e  of  the  itching,  he  had 
been  compelled  to  scratch  until  blood  flowed,  and  even  to  introduce  his  finger 
nail  within  the  margin  of  the  anus,  when  on  withdrawing  it,  he  had  removed 
a  living  oxyuris.  About  ten  o'clock  in  the  evening  the  oxyuris  especially 
tormented  him  by  descending  into  the  lower  portion  of  the  rectum,  and  even 
within  the  contracted  sphincter.  He  had,  besides,  a  constant  acid  taste  in 
his  mouth,  and  he  passed  a  large  quantity  of  saliva  on  his  pillow,  during  the 
night. 

Of  all  the  means  prescribed  for  this  patient,  the  administration  of  cold 
enemata,  and  the  exhibition  of  calomel,  were  the  most  efficacious.  The 
first  injections  were  employed  at  a  temperature  of  from  18°  to  20°  of 
Keaumur,^  and  they  were  afterwards  used  at  15°  and  even  at  12°  of  the 
same  scale.^  Experience  soon  taught  the  patient  that  he  received  most 
benefit  from  their  administration  about  ten  o'clock  in  the  evening,  at  the 
time  when  the  ascarides  descended  near  the  anus,  of  which  he  became 
aware,  by  the  increased  itching  excited.  He  found  also  that  in  order  to 
obtain  the  utmost  benefit  from  the  injections,  it  was  necessary  to  throw  a 


'  Between  70°  and  80°  of  Fahrenheit. 

2  About  59°  and  68°  of  Fahrenheit's  scale. 


116  CAUSES    OF    SPERMATOERHCEA. 

large  quantity  of  water  into  the  intestine,  as  high  as  possible,  and  after- 
wards to  pass  it  suddenly  so  as  to  expel  the  ascarides  inhabiting  the  upper 
part  of  the  intestine,  at  the  moment  when  they  are  benumbed.  By  these 
means  large  quantities  of  the  entozoa  were  passed  on  several  successive  days; 
after  their  expulsion  the  involuntary  emissions  diminished  rapidly  and  per- 
manently, and  all  the  accidents  arising  from  them  disappeared ;  the  patient's 
strength  and  embonpoint,  especially,  returned  very  quickly.  The  involuntary 
emissions,  however,  only  ceased  entirely  under  the  influence  of  a  natural 
exercise  of  the  organs,  with  the  use  of  cold  bathing,  and  gymnastic  exercise. 
The  patient  had  previously  been  obliged,  on  two  occasions,  to  give  up  the 
use  of  the  cold  bath — once  during  the  heat  of  summer,  because  he  was  un- 
able to  obtain  a  proper  reaction  on  quitting  the  water;  yet  immediately  that 
his  system  had  recovered  a  little  strength,  he  found  himself  much  benefited 
by  cold  bathing ;  indeed,  after  the  expulsion  of  the  ascarides,  it  produced 
more  benefit  than  any  other  means  employed,  and  he  even  commenced  the 
use  of  the  cold  plunge  during  the  winter,  with  considerable  advantage. 

Walking  exercise  was  also  very  useful,  and  this  perhaps  it  was  that  in- 
duced M.  D ,  after  having  completed  his  medical  education  at  Mont- 

pellier,  to  turn  his  attention  to  the  study  of  natural  history.  He  has  since 
undertaken  long  and  dangerous  travels  in  the  service  of  science,  and  the 
works  he  has  published  bear  the  stamp  of  an  observing  mind,  and  a  high 
range  of  thought.     His  labors  have  always  been  favorably  received  by  the 

academy  of  sciences.    M.  D 's  health  has  been  completely  re-established 

twenty-five  years. 

The  history  sent  to  me  by  M.  I) was  full  of  interest;  it  showed 

a  kind  of  fatality  pursuing  him,  although  he  struggled  with  courage 
and  perseverance  against  troubles  which  he  had  not  deserved.  It  is 
necessary  to  have  undergone  such  sufferings,  and  to  write  under  their 
immediate  influence,  in  order  to  relate  all  their  circumstances  with 
correctness.     An  uninterested  observer  would  be  unable  to  do  justice 

to  such  a  recital.     How  many  such  persons  as  M.  D do  we  not 

meet  with,  constantly  exposed  to  the  relentless  animadversions  of 
society,  when  they  ought  to  be  regarded  with  pity,  and  to  be  relieved 
from  their  sufferings  by  the  healing  hand  of  the  physician  ! 

Two  of  the  patients,  whose  easel  have  just  related  (cases  twenty- 
three  and  twenty-four),  who  suffered  in  infancy  from  ascarides,  were 
addicted  to  masturbation,  even  before  the  age  of  puberty.  They 
afterwards  reproached  themselves  bitterly,  and  attributed  all  their 
misfortunes  to  this  fatal  habit.  But  it  appears  to  me  that  in  order 
to  induce  such  a  habit  spontmieously,  at  so  early  an  age,  long  before 
the  full  development  of  the  genital  organs,  a  degree  of  abnormal 
irritation  must  be  present  in  them. 

The  irritation  caused  by  stone  in  the  bladder  often  excites,  in 
male  infants,  premature  erections,  and  pain  referred  to  the  fossa 
navicularis;  this  they  relieve  by  elongating  the  penis,  so  that  in  such 
patients,  as  is  well  known,  the  prepuce  is  of  unnatural  length.  These 
manoeuvres  naturally  lead  them  to  habits  for  which  they  ought  not, 
under  such  circumstances,  to  be  held  morally  responsible. 


INFLUENCE  OF  THE  RECTUM.  117 

The  irritation  produced  by  ascarides  in  the  rect«m  constantly  ex- 
cites the  same  phenomena,  and  I  have  frequently  seen  children  two 
or  three  years  of  age  affected  with  priapism,  which  could  be  referred 
to  no  other  cause.  This  circumstance  is  so  common,  that  it  has  been 
frequently  mentioned  to  me  by  nurses,  who  even  employ  a  popular 
remedy  to  relieve  it,  showing,  at  least,  that  the  influence  of  the  asca- 
rides is  well  known.  Nurses  introduce  a  suppository  of  lard  into  the 
rectum,  under  the  impression  that  the  ascarides  come  there  in  search 
of  food,  and  that  they  will  be  able  to  remove  them  together  with  the 
lard,  on  withdrawing  it.  The  cause  of  these  premature  erections 
cannot,  therefore,  be  doubted. 

Such  children  must,  in  consequence  of  the  irritation  of  the  parts, 
possess  an  irresistible  tendency  to  handle  them,  just  as  they  have, 
under  the  same  circumstances,  to  scratch  and  rub  the  nose  ;  and  the 
sensation  resulting  from  the  friction  of  the  genital  organs  being  very 
acute,  is  likely  enough  to  form  the  basis  of  a  more  mischievous  habit. 
When,  on  reaching  puberty,  reason  assumes  its  empire,  the  patients 
often  acquire  sufficient  command  over  themselves  to  renounce  these 
fatal  practices,  and  they  then  suffer  from  involuntary  emissions 
arising  from  the  same  cause  that  excited  the  masturbation  ;  that  is  to 
say,  from  the  irritation  of  the  genital  organs  by  the  worms  inhabiting 
the  rectum. 

Ascarides  produce  nearly  the  same  effects  in  the  female  ;  I  have 
seen  many  little  girls  of  tender  age,  who  were  tormented  by  irresistible 
itching  of  the  pudendum,  and  profuse  leucorrhoea,  often  accompanied 
with  redness  and  excoriation  of  the  clitoris  and  labia  minora,  all 
arising  from  the  same  source  of  irritation. 

The  involuntary  emissions  of  semen  which  accompany  defecation 
in  those  patients  who  are  affected  with  ascarides,  cannot  be  attributed 
to  mechanical  compression  of  the  seminal  vesicles,  for  costiveness  is 
not  present,  nor  could  constipation  account  for  the  nocturnal  emis- 
sions ;  it  appears  to  me  that  the  titillation  constantly  exercised  on 
the  rectum  and  margin  of  the  anus,  by  the  ascarides,  extends  its 
influence  to  the  genital  organs,  and  excites  spasmodic  contractions  of 
the  seminal  vesicles. 

CASE  XXVI. 

The  liahit  of  masturbation  contracted  sponta^ieousJy  at  the  age  of  fifteen, 
and  continued  until  the  age  of  twenty — Nocturnal  and  diurnal  pollutions 
— Increasing  disorder  of  the  health  until  the  age  of  twenty-nine — Frequent 
and  prolonged  erections — Pain  at  the  margin  of  the  anus,  cC-c  — Cauteri- 
zation performed  toithout  henefit — The  expidsion  of  ascarides  folloiced  by 
rapid  recovery. 

M.  E ,  a  student  of  medicine,  enjoyed  good  health  ia  his  childhood, 

but  about  the  age  of  fifteen  was  tormented  by  frequent  and  prolonged  erec- 
tions. One  evening,  for  the  relief  of  the  itching,  of  which  the  extremity  of 
the  penis  was  the  seat,  he  rubbed  the  organ  violently  between  his  hands. 
This  led  to  the  establishment  of  masturbation  as  a  habit  or  rather  as  a  paa- 
8 


113  CAUSES    OF    SPERMATORRHCEA. 

sioD,  the  patient  practising  it  sometimes  as  often  as  eight  or  ten  times  a  day. 
His  health  by  degrees  beeame  so  altered  that  one  of  his  friends  suspected  his 
practices,  and  told  him  the  danger  of  his  situation.  By  degrees  he  cor- 
rected himself,  though  not  entirely,  before  he  had  attained  his  twentieth 
year.  On  his  renouncing  masturbation,  nocturnal  emissions  supervened, 
and  often  occurred  two  or  three  times  a  night.  They  diminished  after  a 
time  but  without  ceasing  entirely,  and  seminal  emissions  during  defecation 
and  the  emission  of  urine  were  added  to  them.  Thus  his  health  became 
daily  more  and  more  disordered  for  nine  years,  notwithstanding  absolute 
continence,  a  severe  regimen,  and  the  use  of  sedatives,  tonics,  and  anti- 
spasmodics. At  length  he  grew  incapable  of  any  mental  exertion.  In 
1837,  he  came  to  Montpellier,  at  the  age  of  twenty-nine,  in  the  following 
condition :  Extreme  emaciation ;  face  pale ;  appearance  stupid  and  con- 
fused; intellect  dull;  reasoning  powers  much  affected,  the  patient  being 
incapable  of  connecting  two  ideas  on  the  most  simple  topic  of  conversation ; 
loss  of  memory  ;  constant  headache  referred  to  the  forehead  and  temples,  and 
increased  by  any  mental  excitement,  being  then  accompanied  by  nervous 
tremors,  and  an  almost  idiotic  state ;  sleep  broken  and  unrefreshing ;  con- 
stant sighing  ;  frequent  attacks  of  congestion  of  the  head,  especially  at  night ; 
violent  noise  in  the  ears  resembling  the  sound  of  a  waterfall ;  vertigo;  stun- 
ning sensations  giving  rise  to  a  constant  fear  of  apoplexy ;  timidity  carried 
to  a  ridiculous  extent ;  panics  of  fear  even  during  the  day ;  character 
gloomy,  taciturn,  restless,  and  irritable  ;  horror  of  the  least  noise,  and  of  all 
society;  irresistible  restlessness;  great  weakness;  abundant  sweats  after 
very  slight  exertion  ;  almost  constant  coryza ;  frequent  dry  and  hard  cough  ; 
pains  in  the  base  of  the  chest,  the  region  of  the  heart,  and  along  the  spinal 
column ;  appetite  voracious ;  dragging  at  the  pit  of  the  stomach ;  difficult 
digestion,  accompanied  with  the  development  of  flatus  ;  grinding  of  the 
teeth  during  sleep  ;  burning  at  the  point  of  the  tongue ;  darting  pains  in  the 
bowels,  especially  in  the  rectum ;  obstinate  constipation  alternating  with 
violent  attacks  of  diarrhoea ;  stools  containing  much  mucus,  and  sometimes 
streaked  with  blood;  periodical  pains  at  the  margin  of  the  anus,  in  the 
perineum,  penis,  and  testicles;  urine  passed  in  large  quantities,  and  very 
frequently,  always  throwing  down  a  whitish,  thick,  and  very  abundant 
deposit;  involuntary  emissions  during  defecation,  both  when  constipated  and 
relaxed  ;  frequent  and  prolonged  erections  by  day  as  well  as  by  night ;  with 
constant  presence  of  erotic  ideas. 

On  sounding  this  patient,  I  found  the  urethra  very  sensitive,  especially 
towards  the  neck  of  the  bladder,  and  I  consequently  thought  that  the  noc- 
turnal and  diurnal  pollutions  were  kept  up  by  a  state  of  irritation  arising 
from  masturbation.  I  therefore  proposed  cauterization.  This  was  performed 
on  the  following  day,  and  produced  the  usual  immediate  eflFects,  but  its 
curative  effects  did  not  take  place  as  I  had  anticipated.  I  then  directed  the 
patient  to  notice  his  feces,  and  a  few  days  afterwards  he  told  me  that  he 
had  observed  numerous  little  worms  passed  in  his  stools.  I  now  ordered 
enemata  of  cold  water,  and  salt  and  water,  which,  however,  produced  only 
a  momentary  effect — probably  because  the  ascarides  inhabited  the  upper 
part  of  the  intestine.  A  few  doses  of  calomel,  however,  caused  them  to 
disappear  without  returning ;  and  from  this  moment  the  involuntary  diurnal 
emissions  ceased  entirely,  the  nocturnal  emissions  became  more  and  more 

rare,  and  the  patient's  re-establishment  progressed  very  rapidly.     M.  R 

returned  to  his  studies  with  ardor,  and  long  afterwards  all  functions  were 
perfectly  well  performed. 


INFLUENCE    OF    THE    KECTUM.  119 

It  appears  evident  that  the  irritation  caused  by  the  ascarides  in 
the  rectum  first  led  this  patient  to  practise  masturbation,  and  after- 
wards kept  up  involuntary  seminal  discharges.  I  did  not  discover 
this  at  first,  because  the  history  of  his  case,  sent  me  by  the  patient, 
was  so  long,  and  was  characterized  by  such  disorder  and  want  of 
clearness,  that  I  was  unable  to  arrive  at  any  satisfactory  conclusions 
from  such  a  chaos ;  his  answers  were  still  more  vague  and  uncon- 
nected, so  that  my  attention  had  been  chiefly  attracted  to  the  state 
of  his  intellect,  and  the  abuses  he  had  committed.  But  after  seeing 
the  little  success  of  cauterization,  and  again  reading  his  notes,  I  paid 
more  attention  to  the  circumstances  attending  the  commencement  of 
his  practising  masturbation,  and  I  noticed  several  symptoms  to  which 
I  had  not  before  attached  importance,  such  as  grinding  of  the  teeth 
during  sleep  ;  burning  pain  in  the  point  of  the  tongue ;  pain  in  the 
rectum,  and  at  the  margin  of  the  anus;  the  stools  always  containing 
mucus,  and  sometimes  being  streaked  with  blood;  and  especially  the 
frequency  and  duration  of  the  erections,  and  the  constant  presence 
of  erotic  ideas. 

When  costiveness  is  present  the  stools  rarely  contain  any  quantity 
of  mucus  ;  its  presence  alone,  therefore,  in  such  a  case,  would  indicate 
that  the  rectum  is  irritated. by  ascarides.  But  a  still  more  character- 
istic point  is,  the  long  duration  of  the  erections.  When  involuntary 
spermatic  discharges  are  induced  by  any  cause  except  this,  the  erec- 
tions diminish  in  proportion  as  the  disease  advances,  first  becoming 
incomplete,  and  afterwards  disappearing  entirely.  When,  therefore, 
energetic  and  obstinate  erections  continue,  in  spite  of  the  great  wast- 
ings  of  the  body  produced  by  them,  they  must  be  kept  up  by  some 
other  stimulus  to  the  organs  than  the  natural  one,  and  I  believe 
irritation  by  ascarides  to  be  the  only  cause  capable  of  producing  this 
effect.  This,  on  the  other  hand,  agrees  perfectly  with  what  I  have 
already  stated  concerning  their  influence  on  the  genital  organs. 

CASE  XXVII. 

Masinrhation  at  the  age  of  fifteen — Serious  disorder — The  application  of 
a,  blister  folloived  hy  involuntary  nocturnal  emissions — Cauterization, 
douches,  &c.,  unsuccessful — Expulsion  of  ascarides,  followed  hy  a  rapid 
recovery. 

Situon  G ,  a  vine  dresser,  short,  stoutly  formed,  and  of  sanguineous 

temperament,  reached  the  age  of  fifteen  without  suffering  from  any  disease. 
At  this  period,  while  watching  goats  with  other  children,  he  was  led  by  their 
example  to  practise  masturbation.  At  first,  no  emission  took  place,  but  at 
the  end  of  about  a  month,  his  manceuvres  caused  the  discharge  of  a  few 
drops  of  blood,  with  burning  at  the  root  of  the  penis,  and  pain  in  the  testi- 
cles. Soon  after,  a  general  lassitude  supervened,  with  a  sense  of  fatigue  in 
all  his  body,  and  cold  sweats.  No  semen  was  discharged  for  a  long  time, 
and  during  the  first  five  months  that  seminal  emissions  occurred,  the  dis- 
charge was  very  fluid,  and  produced  very  little  sensation. 


120  CAUSES    OF    SPERMATOEEHCEA. 

After  Simon  G- bad  followed  these  mal-praetices  for  a  few  weeks,  he 

experienced  darting  pain  in  the  stomach ;  flushes  of  heat  in  the  face,  and 
chilliness  about  the  feet.  At  the  age  of  sixteen,  pain  and  creeping  sensa- 
tions along  the  spinal  column  were  added  to  these  symptoms;  and  still  later, 
severe  cramps  in  the  limbs,  and  weakness  of  the  lower  extremities.  At  the 
a^e  of  seventeen,  the  patient  was  much  troubled  with  palpitations  of  the 
heart,  especially  after  masturbation.  His  stools  were  costive,  passed  with 
difliculty  and  pain,  and  often  streaked  with  blood.  These  symptoms  were 
followed  by  lassitude,  pains  in  the  shoulders,  difficult  digestion,  accompanied 
■with  acidity  and  development  of  flatus,  with  increased  palpitations  3  his  sleep 
was  no  longer  sound  and  refreshing. 

At  the  age  of  eighteen,  congestions  of  the  head  supervened,  with  burning 
and  redness  of  the  face,  occurring  as  often  as  five  or  six  times  a  day  ;  the 
patient  suffered  from  heartburn,  and  difficult  respiration,  with  a  sensation  as 
though  his  throat  were  compressed. 

At  the  age  of  nineteen,  he  carried  masturbation  so  far  as  to  produce  san- 
guineous emissions.  His  debility  now  became  so  great,  that  he  was  unable 
to  follow  his  occupation,  or  even  to  walk  a  short  distance  without  frequently 
resting.  The  use  of  wine,  even  in  small  quantities,  always  increased  his 
debility,  and  his  other  disorders.  At  this  time  leeches  were  applied  to  the 
anus ;  blisters  to  the  epigastrium,  nape  of  the  neck  and  shoulders ;  and  re- 
frigerant drinks  were  ordered.  Shortly  after  the  application  of  the  blisters, 
nocturnal  emissions,  preceded  by  erotic  dreams,  occurred  for  the  first  time, 
and  were  followed  by  cramps  in  the  legs,  and  griping  pain  in  the  stomach. 
From  this  period  the  nocturnal  emissions  occurred  nearly  every  night,  and 
frequently  several  times  a  night. 

At  this  time  his  disorder  increased  so  much,  that  a  medical  man  was  con- 
sulted. G confessed  the  cause  of  his  illness ;  promised  to  correct  him- 
self, and  kept  his  word.  The  treatment  consisted  of  leeches  to  the  back  of 
the  neck ;  syrup  of  quinine ;  about  two  hundred  aromatic  baths ;  friction 
with  camphor  over  the  back  of  the  neck,  the  spine,  and  limbs ;  sleeping  on 
a  very  hard  bed,  &c. 

After  having  employed  these  various  means  during  eighteen  months,  with- 
out receiving  the  least  benefit,  G left  off  all  treatment,  and  at  length 

came  to  Montpellier,  and  was  admitted  into  the  hospital  St.  Eloi,  on  the 
14th  of  February. 

G was  then  twenty-two  years  of  age,  and  his  external  appearance 

announced  strength  and  health;  his  embonpoint  was  considerable,  and  his 
face  full  and  red ;  yet  he  was  sad,  weak,  and  without  courage,  in  fact  his 
state  had  not  improved  in  the  least  during  the  two  years  that  he  had  ceased 
to  practise  masturbation ;  and  his  nocturnal  emissions  had  ceased  for  six 
days  at  a  time,  or  longer,  without  his  becoming  any  better.  This  last  cir- 
cumstance made  me  suspect  that  he  suffered,  at  the  same  time,  from  diurnal 
pollutions.  His  stools  were  often  very  constipated;  and  the  hardened  feces, 
accumulating  in  the  rectum,  were  discharged  with  difficulty  and  pain — 
semen  always  escaping,  at  the  same  time,  in  greater  or  less  quantity.  The 
desire  of  micturition  was  frequent  and  sudden,  and  it  generally  aroused 
the  patient  four  or  five  times  during  the  night;  the  last  drops  of  urine  were 
thick,  viscid,  and  followed  by  a  still  more  consistent  matter,  which  remained 
at  the  orifice  of  the  glans.  The  urine  itself  contained  an  abundant  thick, 
whitish,  and  flocculent  deposit,  like  that  thrown  down  by  a  strong  decoc- 
tion of  pearl  barley.     The  mucous  membrane  of  the  urethra  was   very 


INFLUENCE    OF    THE    RECTUM.  121 

sensitive,  especially  towards  the  prostate ;  and  the  passage  of  a  catheter  was 
arrested  by  spasmodic  contraction  of  the  neck  of  the  bladder. 

After  observing  these  symptoms  for  seven  or  eight  days,  on  the  22d  of 
February  I  performed  cauterization  from  the  neck  of  the  bladder  to  the 
membranous  portion  of  the  urethra.  The  following  night  two  very  painful 
nocturnal  emissions  occurred ;  two  more  took  place  on  the  third  night,  and 
they  were  renewed  every  second  or  third  night,  notwithstanding  the  use  of 
baths,  enemata,  cold  douches,  camphorated  emulsions,  and  morphia.  The 
urine  was  little  altered  in  appearance,  and  there  was  little,  if  any,  iqiprove- 
ment  in  the  general  symptoms.  The  sleep  continued  broken  and  unrefresh- 
ing.  The  patient  was  always  disturbed  by  painful  erections,  and  an  uncom- 
fortable itching  at  the  orifice  of  the  urethra.  At  length,  one  day,  he  informed 
me  that  he  had  observed  in  his  feces  numerous  little  worms  about  six  lines 
long,  and  pointed  at  both  ends.  It  was  plain,  therefore,  that  ascarides  were 
present  in  the  rectum,  and  that  before  benefit  could  be  derived  from  any 
other  means,  it  would  be  necessary  to  expel  them.* 


^  The  effects  produced  in  the  followinjif  remarkable  case,  which  has  recently  come 
under  my  notice,  appear  to  me  to  have  been  due,  in  a  great  measure,  to  the  irritation 
excited  by  ascarides ;  and  the  circumstance  so  well  illustrates  the  connection  between 
the  rectum  and  genito-urinary  apparatus,  that  I  am  induced  to  break  through  my 
original  intention,  of  not  adding  any  of  the  results  of  my  own  experience  to  M.  Lalle- 
mand's  very  full  and  complete  treatise,  and  to  publish  the  case  as  it  is  contained  in 
mj  note-book.  Mr.  M ,  aged  about  thirty,  of  florid  complexion,  two  years  mar- 
ried, called  on  me  in  a  state  of  great  mental  excitement  and  distress,  in  the  beginning 
of  March,  1846.  He  told  me  thnt  about  a  week  before,  while  getting  up  one  morning, 
he  had  observed  a  slight  gluey  discharge  between  the  lips  of  the  urethra,  that  he  had 
taken  no  notice  of  the  circumstance,  but  had  employed  himself  about  his  affairs  as 
usual.  He  was  in  perfectly  good  health,  and  in  fact  had  forgotten  the  occurrence, 
until  on  the  third  morning  it  was  recalled  to  his  recollection  by  the  appearance  of  a 
considerable  discharge  in  the  same  situation,  accompanied  with  pain  during  micturi- 
tion. As  he  had  a  slight  cold  at  the  time,  he  attributed  these  symptoms  to  its  effects, 
and  contented  himself,  for  that  day,  with  remaining  within  doors,  and  restricting  his 
diet  to  vegetables  and  slops.  Still,  the  pain  during  micturition  continued,  the  dis- 
charge increased  in  quantity,  and  became  thicker  and  greenish.  He  now  became  a 
prey  to  the  most  harassing  suspicions,  though  he  still  was  unwilling  to  seek  advice,  in 
the  hope  that  the  discharge  would  cease  spontaneously,  as  it  had  arisen.  In  this  state 
the  patient  continued,  viutil  the  morning  of  the  10th  of  j\Iarch,  by  which  time  he  was 
wrought  to  the  highest  pitch  of  mental  excitement  by  the  thoughts  that  constantly 
obtruded  themselves  on  his  mind. 

He  told  me  that  he  had  suffered  from  three  attacks  of  blennorrhagia :  the  first,  a 
very  severe  one,  about  the  age  of  nineteen ;  the  last  about  twenty-five.  He  had 
never  had  any  syphilitic  affection.  With  the  first  attack  of  blennorrhagia,  he  had 
been  confined  to  his  bed  nearly  a  week,  from  irritability  of  the  bladder  attended  with 
strangury,  &c.,  and  that  he  had  frequently,  since  that  time,  suffered  from  slight 
attacks  of  vesical  irritation,  after  exposure  to  wet  or  cold,  or  after  very  slight  excess 
at  table.  He  could  not  account  for  the  present  symptoms  in  any  way,  unless  by  re- 
ferring them  to  a  very  slight  cold  which  had  entirely  passed  off,  or  by  giving  credit  to 
suspicions  which  would  entirely  overthrow  his  domestic  happiness,  and  for  which  he 
had,  otherwise,  not  the  most  remote  cause. 

From  the  state  of  my  patient's  feelings,  I  saw  that  something  must  be  immediately 
done,  to  remove  suspense ;  I,  therefore,  assured  him  that  cases  of  urethral  discharge, 
from  slight  excitement,  were  not  uncommon,  especially  in  persons  like  himself,  who 
had  repeatedly  suffered  from  blennorrhagia,  and  were  predisposed  to  irritability  of 
the  organs.  When  he  became  a  little  more  composed,  on  examining  the  genital  organs, 
I  found  a  viscid  greenish  discharge  from  the  urethra,  not  exactly  resembling  the  ordi- 
nary thick,  dark  discharge  of  blennorrhagia,  but  containing  a  considerable  quantity 
of  mucus,  and  of  a  glairy  consistence.     The  orifice  of  the  urethra  was  neither  swollen 


122  CAUSES    OF    SPERMATORRHEA. 

I  accordingly  ordered  four,  sis,  and  eight-grain  doses  of  calomel,  to  be 
followed  by  injections  for  this  purpose.  The  patient's  condition  immediately 
began  to  improve  rapidly;  his  nocturnal  emissions  ceased;  his  urine  became 
transparent-  the  local  and  general  symptoms  disappeared;  and  he  left  the 
hospital  on  the  1st  of  April  quite  re-established  in  health. 

Masturbation,  excited  by  bad  example,  produced  from  the  first  a 
serious  disorder  in  this  patient's  health.     On  two  occasions  the  prac- 


nor  red,  and  on  inquiry  I  found  that,  althougli  the  patient  suffered  from  painful  erec- 
tions, they  by  no  means  resembled  the  chordee  from  which  he  had  suffered  on  previous 
occasions,  but  that  the  pain  was  rather  situated  in  the  prostatic  and  membranous 
portions  of  the  urethra.  He  suffered  much  from  strangury,  and  his  urine  was  highly 
acid.  The  chief  pain  that  occurred  during  its  emission  was  felt  in  the  perineum,  and 
the  scalding  near  ther  orifice  of  the  urethra,  which  usually  attends  blennorrhagia,  was 
scarcely  sufficient  to  attract  his  notice.  Under  these  circumstances,  believing  the  case 
to  be  .simply  irritation  of  the  neck  of  the  bladder  from  cold,  I  considered  that  I  might 
at  once  relieve  his  anxiety  as  to  the  nature  of  the  discharge,  by  positively  assuring 
him  that  it  was  not  venereal,  and  that  with  care  he  would  probably  be  well  in  a  few 
days. 

I  ordered  for  him  a  warm  hip-bath,  and  some  bicarbonate  of  potass  in  gum-water, 
with  tincture  of  henbane,  and  requested  him  to  abstain  from  all  stimulants,  and  to  be 
careful  to  avoid  exposure  to  cold  or  damp.  The  following  day  he  called  on  me,  con- 
siderably relieved  from  his  strangurj',  and  with  his  urine  in  a  much  more  healthy 
state;  but  the  discharge  continued  as  severe  as  before,  and  there  was  still  consider- 
able paiu  in  making  water.  A  continuance  of  the  sam&  remedies  was  prescribed,  and 
patience  enjoined.  The  two  following  days  the  patient  did  not  call,  and  I  had  begun 
to  suppose  that  he  was  quite  recovered,  when  on  the  15th  he  returned,  almost  as  much 
excited  as  at  first.  He  was  convinced,  he  said,  that  his  disease  was  more  serious  than 
I  had  led  him  to  believe,  and  that  there  was  only  one  way  of  accounting  for  it ;  he 
was  a  ruined  man,  &c.  After  he  had  become  a  little  calm,  he  stated  to  me,  that  the 
irritation  had  returned,  that  the  discharge  was  more  abundant,  and  he  was  convinced, 
that  had  it  been  simple  irritation  of  the  neck  of  the  bladder,  all  these  symptoms  would 
have  ceased  long  before.  He  complained  of  a  burning  heat,  and  a  sense  of  weight  in 
the  rectum,  which  induced  me  to  request  an  examination  of  the  prostate.  When  pro- 
ceeding to  do  so,  I  observed  the  parts  in  the  neighborhood  of  the  anus  red,  hot,  and 
excoriated,  and,  on  questioning,  he  told  me  that  he  had  long  suffered  severely  from 
itching  in  the  neighborhood,  but  that  he  had  omitted  to  mention  it  to  me,  as  he  had 
not  considered  it  of  any  importance,  believing  it  to  arise  from  little  worms  which  he 
often  passed  in  his  stools.  This  fact  threw  a  new  light  on  the  case,  and  I  began  to 
suspect  that  the  irritation  produced  by  ascarides  was  the  cause  of  the  vesical  irritation 
and  urethral  discharge.  On  being  questioned,  he  recollected  that  the  strangury  al- 
ways increased  towards  night,  when  he  generally  suffered  most  from  the  itching  of  the 
rectum,  and  that  he  had  felt  itching  and  severe  burning  pain  in  the  neighborhood  of 
the  rectum  long  before  the  occurrence  of  the  present  attack  of  irritation,  and  before 
the  appearance  of  the  urethral  discharge.  I  now  ordered,  in  addition  to  his  former 
medicines,  a  dose  of  calomel  at  bedtime,  to  be  followed  by  a  smart  purgative  in  the 
morning,  and  a  copious  injection  of  salt  and  water  to  be  thrown  into  the  rectum  as 
rapidly  as  possible,  whenever  he  found  the  irritation  and  itching  very  troublesome. 

The  following  day  the  patient  called  to  let  me  know  that  he  was  much  improved. 
The  purgative,  and  one  injection  which  he  had  used,  had  brought  away  a  perfect  nest 
of  ascarides.  The  injection  was  repeated  on  the  second  night,  and  a  few  entozoa  were 
discharged.  On  the  22d  of  March,  Mr.  D called  to  say  that  the  urethral  dis- 
charge, scalding  and  vesical  irritation,  had  entirely  ceased,  and  that  he  no  longer  suf- 
fered from  the  intolerable  itching  that  had  previously  almost  constantly  annoyed  him  ; 
I  advised  him  to  use  an  enema  occasionally,  for  a  month  or  two,  to  prevent  a  return 
of  his  tormentors ;  this  he  has  done,  and  the  last  time  I  saw  him,  some  months  after 
his  recovery,  he  was  in  excellent  health  and  spirits,  and  able  to  enjoy  all  the  comfort 
of  domestic  felicity. 


INFLUENCE  OF  THE  KECTUM.  123 

tice  was  carried  so  far  as  to  induce  emissions  of  blood.  His  testicles 
became  painful ;  his  urethra  was  exceedingly  sensitive  ;  and  the  ap- 
plication of  blisters  induced  nocturnal  emissions  for  the  first  time.  It 
seemed,  therefore,  unnecessary  to  seek  further  for  the  cause  of  the 
seminal  discharges  which  wore  the  patient  out;  yet  the  result  proved 
that  they  were  kept  up  by  the  presence  of  ascarides  in  the  rectum, 
the  expulsion  of  which  was  followed  by  a  sudden  change  and  rapid  im- 
provement, whilst  no  other  treatment  had  produced  the  least  amend- 
ment. This  case  shows  how  important  it  is  to  seek  all  the  causes 
which  may  either  excite  or  keep  up  involuntary  seminal  emissions. 

I  say  excite  or  keep  up,  because  in  this  case  the  ascarides  do  not 
appear  to  me  to  have  at  all  contributed  to  produce  the  disorder  at  its 
commencement.     It  was  by  the  influence  of  bad  example  that  Simen 

G was  led  to  practise  masturbation,  and  not  by  the  presence  of 

priapism,  as  is  the  case  when  the  habit  is  excited  by  irritation  from 
ascarides.  The  first  nocturnal  emissions  too,  followed  the  applica- 
tion of  blisters ;  and  I  shall,  in  a  future  chapter,  have  occasion  to 
relate  other  cases  of  the  same  nature  :  such  occurrences  are  easily 
explained  by  absorption  of  the  cantharides.  It  seems  likely,  then, 
that  the  ascarides  were  only  developed  at  a  later  period,  and  perhaps 
as  a  consequence  of  the  deranged  state  of  the  patient's  digestive 
organs.  As  they  were  not  present  in  any  very  great  quantity  it 
appears  likely  that  they  would  not  have  produced  such  serious  effects, 
if  the  spermatic  organs  had  not  been  previously  in  a  state  of  irrita- 
tion ;  but  I  believe  that  in  the  existing  state  of  the  parts,  the  presence 
of  the  worms  was  sufficient  to  keep  up  involuntary  nocturnal  and 
diurnal  emissions.  By  reflecting  on  a  few  of  the  symptoms  that 
attended  the  spermatorrhoea  in  this  case,  I  might  have  earlier  dis- 
covered the  presence  of  ascarides  ;  thus,  the  erections  were  frequent, 
prolonged,  and  importunate — circumstances  the  opposite  of  those 
observed  in  patients  worn  out  by  ordinary  pollutions.  The  trouble- 
some itching,  also,  which  constantly  existed  at  the  root  of  the  penis, 
should  have  aroused  my  suspicions. 

CASE  XXVIII. 

Masturbation  at  the  age  of  ten — Seminal  emissio7is  produced  hy  horse  ex- 
ercise— Nocturnal,  and  afterwards  diurnal,  pollutions — Constant  erec- 
tions— Stools  relaxed,  and  containing  abundance  of  mucus — Burning  in 
the  amis.  Cauterization  icitli  slight  benefit — Expidsion  of  ascarides  fol- 
lowed by  rapid  and  complete  recovery. 

Alexander  A ,  of  moderate  stature,  the  son  of  robust  peasants,  en- 
ticed by  the  example  of  his  companions,  contracted,  when  about  ten  years 
old,  the  habit  of  masturbation,  which  he  practised  for  a  year  before  he  ob- 
tained any  seminal  emission.  From  seventeen  to  eighteen  he  had  sexual 
intercourse,  but  he  afterwards  returned  to  his  former  habits.  He  soon 
complained  of  general  lassitude,  weakness  of  the  extremities,  shortness  of 
breath,  and  a  sense  of  suffocation  after  the  least  exertion;  loss  of  appetite  ; 


124:  CAUSES    OF    SPERMATORRHEA. 

difficulty  of  digestion.  Very  abundant  seminal  emissions  were  frequently 
excited  by  borse  exercise,  and  occurred  without  erection,  although  not 
without  slin-ht  sensation.  At  a  later  period  he  suffered  from  severe  and 
prolonged  palpitation  from  slight  causes;  frequent  colds,  and  an  almost 
habitual  cough,  attended  with   expectoration  of  mucus  mixed  with  much 

blood.     At  this  period,  A mentioned  his  condition  to  a  medical  man, 

who  explained  the  cause  of  his  disorders,  and  A at  once  corrected  him- 
self; but  nocturnal  pollutions  soon  appeared.  At  first  these  were  very  fre- 
quent, but  after  a  short  time  they  only  occurred  three  or  four  times  a  week, 
and  at  last  only  three  or  four  times  a  month.  Still  the  patient's  palpitations, 
difficulty  of  breathing,  and  digestive  disorder,  continued  to  increase.  Flushes 
of  heat  to  the  head  were  added  to  these  symptoms,  together  with  pain  in  the 
loins,  which  extended,  with  a  creeping  sensation,  along  the  vertebral  column, 
and  was  distributed  to  the  shoulders  and  arms ;  frequent  cramps  and  chilli- 
ness of  the  extremities ;  extreme  weakness  of  the  legs,  and  a  frequent  desire 
to  micturate  and  defecate.  The  patient  gave  up  music,  in  which  he  was  a 
proficient,  and  took  a  dislike  to  society,  especially  that  of  women:  timid, 
irritable,  and  unsettled,  incessantly  occupied  by  thinking  of  his  disease,  he 
was  unfit  for  any  occupation,  became  a  prey  to  despair,  and  was  several  times 
on  the  point  of  yielding  to  the  impulse  to  suicide,  which  constantly  obtruded 
itself  before  him. 

In  this  condition  A came  to  consult  me,  in  the  month  of  October, 

1836,  being  then  twenty-one  years  of  age.  T  at  once  perceived  that  the  noc- 
turnal emissions  bad  given  place  to  diurnal  ones,  and  the  minute  details  into 
which  the  patient  entered,  confirmed  me  fully  in  this  opinion.  Each  time 
that  he  went  to  stool,  he  had  an  emission  from  the  penis  of  a  greater  or  less 
quantity  of  viscid  matter,  which  presented  the  characteristics  of  badly  formed 
semen.  His  stools  were  repeated  two  or  three  times  a  day  ;  they  were  liquid, 
contained  a  large  quantity  of  mucus,  and  left  a  severe  burning  pain  in  the 
rectum.  His  urine  was  habitually  muddy,  thick,  and  of  a  disagreeable  smell, 
and  after  its  emission  a  thick  gummy  matter,  which  left  a  mark  on  his  linen, 
remained  at  the  orifice  of  the  glans  The  patient  was,  besides,  annoyed  day 
and  night,  with  incomplete  but  very  constant  erections. 

Having  observed,  for  several  days,  the  presence  of  semen  in  the  urine,  I 
performed  cauterization  of  the  prostatic  portion  of  the  urethra.  Fifteen  days 
afterwards,  a  sensible  improvement  was  evident  in  almost  all  the  symptoms  ; 
yet  no  further  progi'ess  was  made,  notwithstanding  the  use  of  Spa  water,  iced 
milk,  &c.  The  stools  still  continued  liquid  and  mixed  with  mucus,  resem- 
bling a  thick  solution  of  soap  in  water.  This  really  dispiriting  condition 
continued  during  three  months,  when  I  learned  that  the  patient  had  several 
times  noticed  ascarides  in  his  stools. 

In  a  few  days  after  he  was  freed  from  this  .source  of  irritation  by  means  of 
injections,  and  from  that  moment  his  re-establishment  progressed  rapidly. 
His  love  of  occupation  soon  returned,  and  he  applied  himself  diligently  to 
the  study  of  pharmacy. 

This,  then,  was  a  case  in  Avhich  the  involuntary  emissions  were 
kept  up  by  the  irritation  of  ascarides  in  the  rectum,  although  it  would 
appear  that  masturbation  was  the  cause  of  their  origin.  I  have  re- 
cently been  consulted  by  one  of  my  former  pupils,  for  a  similar  case, 
in  which  the  discbarges  were  very  serious,  and  had  resisted  the  most 


I 


INFLUENCE    OF   THE    RECTTJM:.  125 

various  modes  of  treatment.  They  were  attributed  to  masturbation, 
and  the  patient's  confessions  justified  this  opinion  ;  yet  a  passage  in 
his  letter  convinced  me  that  a  mistake  had  arisen  on,  at  least,  one 
point.  After  speaking  of  supposed  hremorrhoids,  which  irritated  the 
margin  of  the  anus,  the  patient  added  that  the  pain  and  itching  he 
felt  there  were  such,  that  he  often  introduced  his  finger  forcibly  into 
the  rectum,  and  had  several  times  brought  down  ascarides  on  with- 
drawing it.  This  circumstance,  previously  neglected,  caused  me  to 
think  that  the  ascarides,  if  they  had  not  caused  the  pollutions,  at  all 
events  kept  them  up,  and  I  prescribed  accordingly,  with  success. 
We  must  remember,  then,  that  the  emissions  may  be  kept  up  in  per- 
sons who  have  practised  masturbation,  by  the  presence  of  ascarides, 
even  in  cases  in  which  these  entozoa  have  not  excited  the  habit; 
and  on  this  account  it  is  necessary  to  consider  their  presence  with 
much  attention.  On  the  other  hand,  we  must  be  on  our  guard  against 
attaching  too  much  importance  to  the  occasional  presence  of  one  or 
two  of  these  worms  in  the  feces.  In  such  cases,  the  want  of  success 
of  vermifuge  remedies  shows  that  the  ascarides  are  not  of  so  much 
importance  as  they  may  have  been  considered.  We  must,  therefore, 
be  careful  in  all  cases,  not  to  draw  conclusions  too  precipitately  from 
first  appearances.  No  disease,  in  fact,  requires  more  patient  research 
and  greater  tact  in  its  diagnosis  and  treatment,  than  are  necessary 
in  complicated  cases  of  spermatorrhoea. 

To  resume.  The  cases  reported  in  this  chapter  show  that  affec- 
tions of  the  rectum  excite  involuntary  emissions.  First,  mechani- 
cally;  by  compressing  the  seminal  vesicles  diiring  the  passage  of 
feces.  Secondly,  vitally  ;  by  the  extension  of  irritation  from  the 
rectum  to  the  seminal  vesicles. 

All  causes  which  oppose  an  obstacle  to  the  exit  of  feces  act  in  the 
former  manner.  I  have  recorded  cases  in  which  the  mechanical 
obstacle  was  placed  at  the  margin  of  the  anus  (cases  15, 16,  17,  and 
18),  because,  in  such  cases,  the  cause  is  perfectly  isolated,  and  its 
action  is  evident ;  but  it  is  also  evident  that  any  physical  action  like 
that  resulting  from  horse  exercise  (nineteenth  case),  from  carriage 
exercise,  or  from  remaining  too  long  in  a  sitting  posture,  as  well  as 
all  medicines  which  tend  to  produce  constipation,  may  be  followed 
by  the  same  effects.  In  all  cases  of  this  kind  the  influence  of  the 
rectum  on  the  seminal  vesicles  arises  from  its  distension  by  feces, 
and  is  a  perfectly  mechanical  action. 

The  other  phenomenon  is  essentially  vital.  The  diarrhoea  (case 
sixteenth),  the  ascarides  (cases  22,  23,  24,  25,  26,  27,  28),  and  the 
eruptions  at  the  anus  (case  twelve),  could  only  act  in  this  manner. 
The  same  may  be  said  concerning  the  action  of  injections,  either  too 
hot  or  too  cold,  and  of  certain  drastic  purgatives. 

In  many  cases,  too,  the  distension  and  the  irritability  of  the  intes- 
tine act  simultaneously  on  the  seminal  vesicles.  Haemorrhoids  and 
fissures  of  the  anus,  for  instance,  cause  pain  and  irritation,  and  give 
rise  to  spasms  of  the  sphincter,  at  the  same  time  that  they  form  an 


126  CAUSES    OF    SPERMATOERHCEA. 

obstacle  to  defecation.  Obstinate  and  continued  costiveness,  too,  is 
rarely  exempt  from  heat  and  irritation  in  the  rectum  and  its  neigh- 
borhood ;  and  eruptions  about  the  anus  are  often  accompanied  by  an 
irritability  of  the  sphincters,  opposing  defecation. 

We  have  seen  (case  twenty-one)  that  chronic  inflammation  of  the 
urinary  organs  may  excite,  by  its  influence,  so  great  a  susceptibility 
of  the  rectum,  that  the  feces  are  no  longer  able  to  be  retained  ;  and 
here  cauterization  of  the  mucous  membrane  of  the  genito-urinary 
passage  sufficed  to  dispel  the  irritation  of  the  rectum,  so  that  the 
patient  got  rid,  at  once,  of  his  diarrhoea,  his  incontinence  of  urine, 
and  his  involuntary  seminal  discharges.  The  influence  of  the  rec- 
tum on  the  genito-urinary  organs  is  then  reciprocal ;  and  it  plays  a 
much  more  important  part  in  causing  spermatorrhoea,  than  if  it 
acted  only  by  mechanically  compressing  the  seminal  vesicles.  Its 
due  consideration  is,  therefore,  of  much  importance  in  the  treatment 
of  these  cases. 


CHAPTER  VI. 

CAUSES  OF  SPERMATORRHEA. 
Abuse. 

I  UNDERSTAND  by  the  term  abuse,  when  applied  to  the  organs  of 
generation,  any  irregular  or  premature  exercise  of  their  functions  ; 
any  application  of  them  which  cannot  have,  as  its  result,  the  propa- 
gation of  the  species.  There  are,  undoubtedly,  many  points  of  re- 
semblance between  such  abuses  and  venereal  excesses,  but  the  plan 
of  this  work  requires  that  I  should  examine  them  separately. 

I  concluded  the  last  chapter  by  relating  some  cases  in  which  the 
presence  of  ascarides  in  the  rectum,  more  or  less  connected  with 
masturbation,  induced  or  kept  up  involuntary  spermatic  discharges  ; 
I  shall  commence  the  present  one  by  relating  some  cases  in  which 
the  spermatorrhoea  was  due  to  masturbation  alone. 

CASE  XXIX. 

Masfurhation — Nocturnal  pollutions — Palpitation  and  dyspnoea,  simulating 
cardiac  disease — Repeated  venesection,  folloioed  by  increased  disorder — 
Sulphuretted  baths  and  rapid  recovery. 

M.  D ,  of  nervous  temperament,  and  energetic  and  restless  charac- 
ter, contracted  the  practice  of  masturbation  while  at  school.  Shortly  after- 
wards he  suffered  from  a  severe  attack  of  fever,  which  occasioned  his  re- 
moval ;  this  fever  was  followed  by  loss  of  voice,  and  afterwards  by  rheu- 


ABUSE.  127 

uiatic  pains,  pain  in  the  chest,  sensation  of  suffocation,  habitual  shortness 
of  breath,  and  violent  palpitations,  which  were  increased  on_  the  slightest 
exertion.  At  the  age  of  nineteen  he  broke  himself  of  his  habits  ;  but,  soon 
afterwards  he  experienced  nocturnal  pollutions,  which  became  daily  more 
and  more  frequent.  About  this  time  an  issue  was  inserted  in  his  loft  thigh. 
The  following  winter  the  palpitations  and  difficulty  of  breathing  increased, 
and  his  legs  became  slightly  oedematous ;  he  was  treated  by  repeated  vene- 
sections, and  the  administration  of  diuretics,  and  at  the  approach  of  summer 
he  became  a  little  better,  the  improvement  being  of  course  attributed  to  the 
effects  of  the  medical  treatment. 

The  following  winter  the  same  symptoms  reappeared,  and  were  again 
combated  by  venesection,  with  a  severe  regimen.  The  patient  now  became 
exceedingly  emaciated.  His  nocturnal  emissions  increased  in  frequency,  and 
his  dyspnoea  and  palpitations  were  aggravated.  For  these  symptoms  he  was 
again  hied  three  times. 

At  the  age  of  twenty-three  M.  D came  to  Montpellier.     A  minute 

examination  of  his  chest  assured  me  that  his  lungs  were  perfectly  healthy, 
and  that  the  heart's  action  was  neither  more  violent,  nor  heard  over  a  greater 
extent  than  natural ;  still,  notwithstanding  his  emaciation  and  extreme 
debility,  and  the  oedematous  state  of  his  legs,  he  was  constantly  recurring  to 
the  supposed  plethora,  to  which  his  attendants  had  attributed  his  symptoms. 
I  found  it  difficult  to  prevent  him  from  having  recourse  to  further  abstrac- 
tion of  blood. 

The  use  of  artificial  sulphuretted  baths  gave  tone  to  his  genital  organs, 
and  diminished  their  excessive  irritability.  The  nocturnal  pollutions  be- 
came less  frequent ;  the  patient's  appetite  returned,  and  his  digestion  was 
performed  with  greater  energy.  After  a  month's  treatment,  I  sent  him  to 
the  sulphuretted  waters  of  the  Pyrenees,  where  his  cure  was  soon  com- 
pleted. 

This  is  one  of  the  most  simple  cases  of  nocturnal  pollutions  in- 
duced by  masturbation.  It  is  chiefly  remarkable  on  account  of  the 
predominance  of  the  palpitations  and  dyspnoea  over  the  other  symp- 
toms, and  the  grave  errors  which  have  been  committed  in  its  diag- 
nosis and  treatment. 

CASE  XXX. 

IJaRtiirhdtion  at  the  age  of  eight  years — At  twelve  very  frequent  emissions 
of  xirine — At  sixteen,  coitus  impossible — Nocturnal,  and  afterwards,  diur- 
nal pollutions —  Cauterization  at  the  age  of  twenty-eight  followed  hy  rapid 
recovery. 

M.  D ,  of  Philadelphia,  of  a  very  robust  constitution,  contracted  the 

habit  of  masturbation  at  school,  when  only  eight  years  old.  The  first  effect 
produced  was  a  frequent  desire  to  pass  urine,  and  at  twelve  years  of  age 
this  irritability  had  become  so  great,  that  he  was  sometimes  unable  to  retain 
his  urine  a  quarter  of  an  hour.  Before  entering  a  house  he  always  took 
care  to  micturate  several  times  in  rapid  succession  ;  and,  notwithstanding 
this  precaution,  he  soon  experienced  renewed  uneasiness.  He  felt  as 
though  his  bladder  was  never  entirely  empty,  and  the  smallest  quantity  of 
urine   induced   spasmodic   contractions.     The   irritability    of   the    urinary 


128  CAUSES    OF    SPERMATOERH(EA. 

organs  diminished  by  degrees  after  the  period  of  puberty,  but  never  ceased 
entirely,  notwithstanding  the  various  means  which  were  employed  on  differ- 
ent occasions. 

At  the  ao-e  of  sixteen,  M.  D endeavored  to  break   off  his  injurious 

habits  by  sexual  intercourse,  but  he  found  himself  completely  impotent,  and 
shame  induced  him  to  return  to  masturbation.  He  afterwards  made  further 
attempts  to  correct  himself,  but  he  experienced  nocturnal  pollutions,  which 
often  made  him  lose  courage.  At  length,  after  many  relapses,  he  succeeded 
completely,  without  observing  any  further  nocturnal  emissions.  Still  his 
health,  instead  of  improving,  became  more  and  more  impaired.  His  erec- 
tions were  less  frequent,  less  prolonged,  incomplete,  and  at  length  gradually 
ceased,  together  with  all  venereal  desire. 

At  the  age  of  twenty-eight,  the  state  of  his  urine,  its  frequent  discharge, 
and  the  wandering  pains  in  the  perineum  and  testicles,  induced  a  fear  of  cal- 
culus ;  sounding,  however,  only  showed  a  morbid  sensibility  of  the  urethra, 
especially  towards  the  neck  of  the  bladder. 

In  the  beginning  of  May,  1837,  M.  D came  to  Montpellier,  in   the 

following  condition  : — much  debilitated  ;  unsteady  in  his  walk ;  easily  chilled, 
and  taking  cold  very  quickly ;  wandering  pains  all  over  his  body  ;  skin  dry  ; 
memory  impaired ;  digestion  difficult ;  extremities  cold ;  scrotum  relaxed, 
and  testicles  soft,  very  sensitive,  and  often  causing  a  dull  pain,  as  if  they 
were  forcibly  compressed  ;  the  semen  (from  the  account  he  gave  of  the  last 
nocturnal  pollutions  he  had  experienced),  clear,  aqueous,  and  inodorous  ; 
seminal  emissions  with  the  last  drops  of  urine,  which  were  clammy,  and 
passed  with  difficulty,  and  excited  a  sensation  of  tickling  in  the  neighbor- 
hood of  the  anus,  which  extended  to  the  orifice  of  the  urethra;  he  often  had 
diarrhoea,  but  at  other  times  was  very  costive,  and  his  stools  were  passed 
with  difficulty  and  pain.  He  did  not,  however,  often  pass  semen  while  at 
stool. 

I  discovered,  several  days  following,  the  presence  of  semen  in  M.  D 's 

urine,  and  catheterism  showed  an  excessive  irritability  of  the  urethi-a,  espe- 
cially in  the  neighborhood  of  the  prostate,  which,  on  examination,  was 
found  slightly  enlarged.  Nearly  a  tablespoonful  of  blood  followed  the 
withdrawal  of  the  catheter.  These  circumstances  did  not  leave  the  least 
doubt  on  my  mind  as  to  the  state  of  the  mucous  membrane  in  the  vicinity 
of  the  ejaculatory  ducts ;  and,  consequently,  I  immediately  performed  cau- 
terization, from  the  neck  of  the  bladder,  as  far  as  the  membranous  portion  of 

the  urethra.     Twenty  days  afterwards,  M.  D left  Montpellier  for  Italy, 

and  when  he  returned,  three  months  afterwards,  he  was  completely  cured — 
no  involuntary  seminal  Amissions  having  afterwards  appeared.  His  urine 
was  transparent,  and  could  be  retained  seven  or  eight  hours  without  incon- 
venience ;  its  discharge  took  place  without  effort,  and  was  not  accompanied 
by  any  remarkable  sensation.  Lastly,  the  patient's  impotence,  which  had 
been  present  nearly  twelve  years,  had  given  place  to  a  virility  previously  un- 
known to  him  :  I  need  hardly  state  that  his  physical  and  moral  energy  had 
shared  in  this  regeneration. 

I  have  often  had  occasion  to  notice  the  connection  that  exists  be- 
tween the  spermatic  and  urinary  organs  ;  and  I  have  shown  that  there 
is  scarcely  a  cause  of  spermatorrhoea  which  does  not  act  more  or  less 
on  the  bladder  and  kidneys.     The   cause   I   am   now   investigating 


! 


ABUSE.  129 

affords  us  numerous  examples  of  this  connection — of  which  the  case 
I  have  just  related  is  a  remarkable  instance — the  irritation  of  the 
urinary  organs  having  been  developed  very  rapidly,  having  shown 
very  marked  symptoms,  and  having  existed  alone  during  several 
years.  The  patient  was  only  eight  years  of  age  when  he  first  became 
addicted  to  masturbation ;  at  this  early  age  the  urinary  organs  alone 
possessed  activity,  and  therefore  they  alone  were  able  to  suffer  dis- 
turbance of  their  functions  ;  on  this  account  the  symptoms  were  con- 
fined for  a  long  time  to  the  urinary  organs.  The  character  of  the 
symptoms  showed  that  they  arose  from  a  chronic  state  of  inflammation, 
or  from  an  acute  irritation  of  the  urinary  organs,  and  this  state  must 
have  extended  also  towards  the  spermatic  organs.  Thus  the  in- 
creased secretion  of  the  kidneys,  and  the  extreme  irritability  of  the 
bladder,  would  give  a  very  clear  idea  of  what  took  place  in  the  sper- 
matic organs  at  the  period  of  puberty.  As  soon  as  the  testicles  began 
to  act,  they  fell  under  the  same  influence  as  the  kidneys  ;  the  semi- 
nal vesicles  were  in  the  same  condition  as  the  bladder  ;  in  other  words, 
the  semen  was  secreted  in  large  quantities,  and  was  retained  a  very 
short  time  in  its  reservoirs.  Being,  therefore,  imperfectly  formed, 
the  usual  effect  on  the  erectile  tissues  produced  by  its  presence,  did 
not  take  place,  and  coitus  was  impossible  at  the  age  of  sixteen.  The 
occurrence  of  impotence  at  so  early  an  age  is  sufficient  to  show  that 
diurnal  pollutions  had  already  commenced,  although  the  patient  did 
not  discover  them  for  a  long  time  afterwards.  He  was  still,  how- 
ever, able  to  practise  masturbation ;  and  this  is  a  circumstance  which 
has  great  effect  in  preventing  persons  addicted  to  the  vice  from  re- 
nouncing their  fatal  habits.  At  a  later  period,  nocturnal  pollutions, 
which  occurred  after  a  few  days'  care,  shook  the  patient's  resolution. 
This  is  a  much  less  serious  circumstance  than  the  one  just  mentioned, 
but  at  the  same  time  much  more  common.  At  length  the  patient 
left  off  his  habits,  and  nocturnal  pollutions  disappeared  ;  yet  the  dis- 
order of  his  health  continued  to  increase.  His  prudence,  exercised 
too  late,  did  not  arise  from  the  strength  of  his  will,  but  from  the 
weakness  of  his  genital  organs  ;  the  disappearance  of  his  nocturnal 
emissions  did  not  arise  from  the  remedial  measures  used,  but  from  the 
increase  of  his  involuntary  diurnal  discharges,  of  which  he  only  be- 
came aware  long  afterwards.  These  common  errors  are  the  more  dan- 
gerous, because  medical  practitioners  are  apt  to  participate  in  them. 

In   the  case  of  M.  D the  irritability  of  the  canal  was  very 

great,  and  the  effect  of  the  cauterization  was  correspondingly  prompt 
and  decided. 


130  CAUSES    OF    SPERMATORRHCEA. 


CASE  XXXI. 

Masturliation  at  the  age  of  seventeen,  carried  so  far  as  to  cause  emissions 
ofhlood,  hut  soon  afterwards  abandoned — Increasing  debility  during  four 
years — Symptoms  of  jjJithisis  laryngea  and  chronic,  gastritis — Extreme 
prostration — Cauterization,  folloiced  by  rapid  re-establishment. 

I  am  indebted  for  the  following  remarkable  case  to  the  kindness  of  Dr. 

Daniel,  of  Cette.     "  On  the  26th  of  May,  1836,  I  was  called  to  F ,  a 

baker,  aged  twenty-two.  I  found  him  in  bed,  in  the  following  condition  : 
great  moral  prostration,  carried  even  to  a  hatred  of  existence ;  prostration 
of  strength ;  emesia ;  lips  pale  and  shrivelled ;  remarkable  pallidity ;  eyes 
sunken;  expression  of  countenance  dull;  great  emaciation;  skin  hot  and 
dry;  pulse  small ;  voice  hoarse,  and  so  low  that  it  was  with  difficulty  a  few 
words  could  be  heard  by  approaching  the  ear;  constant  cough,  scarcely  per- 
mitting an  instant's  repose ;  general  wandering  pains,  most  severe  in  the 
loins  and  the  sides  of  the  chest ;  great  irritability  of  the  stomach — vomiting 
being  excited  after  taking  almost  any  kind  of  liquid  or  solid  food. 

"  At  first  I  thought  that  I  recognized  in  this  patient  the  symptoms  of 
phthisis  laryngea,  complicated  with  chronic  gastritis ;  but  the  examination 
of  his  chest  and  abdomen  did  not  support  this  opinion.  The  epigastric  re- 
gion was  not  painful  on  pressure;  the  respiratory  murmur  was  heard  all  over 
the  chest,  and  percussion  emitted  a  healthy  sound,  except  under  the  left  false 
libs,  where  it  was  slightly  dull,  and  the  patient  felt  pain. 

"  His  debility  did  not  permit  me  to  practise  abstraction  of  blood  ;  and, 
indeed,  the  pleuro-pneumonia  of  the  left  side  did  not  seem  either  very  ex- 
tensive or  very  acute;  I  therefore  ordered  a  large  blister  to  be  applied  over 
the  affected  spot,  and  prescribed  a  solution  of  tartar  emetic,  and  a  strict 
diet.  The  pain  in  the  side  disappeared,  and  two  days  afterwards  the  sto- 
mach could  retain  milk  and  barley-water.  Still  nothing  explained  the 
patient's  emaciation  ;  his  almost  total  loss  of  voice,  hoarseness,  and  constant 
cough.  His  parents  attributed  these  symptoms  to  hereditary  phthisis,  and 
mentioned  that  several  members  of  the  family  had  died  of  that  disease. 

Minute  and  repeated  examination  of  F 's  chest,  however,  assured  me 

that  this  was  not  the  case.  On  the  other  hand,  the  symptoms  were  very 
severe,  and  I  could  not  discover  any  visceral  lesion  sufficient  to  account 
for  them.  In  this  state  of  uncertainty,  your  views  on  spermatorrhoea  at- 
tracted my  attention.  I  immediately  questioned  the  patient  respecting  his 
past  life,  and  learned  that  at  the  age  of  seventeen  he  had  practised  mastur- 
bation with  such  fury  that  he  had  frequently  passed  aqueous  semen,  mixed 
with  blood;  frightened  by  these  accidents,  he  had  corrected  himself  com- 
pletely. But,  after  about  a  fortnight's  abstinence,  he  noticed  that  his  urine 
contained  a  deposit  of  thick,  whitish,  flocculent  matter.  He  never  attached 
any  importance  to  this,  although  during  four  years  he  observed  it  con- 
stantly, and  noticed  that  it  was  more  abundant  after  he  had  been  much 
fatigued  in  his  business.  He  observed  also,  that  the  last  drops  of  urine 
were  thick  and  viscid,  and  that  a  small  quantity  of  viscid  matter  generally 
remained  at  the  orifice  of  the  urethra.  His  bad  symptoms  first  commenced 
at  this  time;  his  erections  and  desires  entirely  disappeared;  and,  by  the 
time  he  had  attained  the  age  of  twenty-one,  he  was  obliged  to  give  up  his 


ABUSE.  131 

employment,  and  shortly  afterwards,  his  symptoms  becoming  aggravated,  he 
was  unable  to  quit  his  bed. 

"  I  examined  his  urine,  and  found  it  in  the  condition  he  had  described; 
the  deposit  contained  in  it  being  about  an  ounce  in  quantity.  I  noticed 
that  his  testicles  were  soft,  and  his  scrotum  flaccid.  He  agreed  to  ray 
proposition  of  cauterizing  the  prostatic  portion  of  the  urethra  with  eager- 
ness, and  I  performed  it  on  the  following  day.  The  eifect  of  the  cauteriza- 
tion was  rapid ;  the  second  night  afterwards,  the  patient  slept  soundly ;  the 
third  day,  a  change  was  observed  in  his  voice  j  and  erections  occurred 
during  the  night.  On  the  fourth  day,  the  patient  was  able  to  get  up  and 
take  some  light  food,  which  was  well  digested;  his  wandering  pains  had 
disappeared ;  and  by  the  ninth  day  after  the  cauterization,  the  patient's 
strength  had  returned.  Tonic  regimen,  and  the  use  of  sea  bathing,  con- 
firmed his  restoration." 

Dr.  Daniel  added  to  the  history  of  this  case  a  detailed  statement 
drawn  up  by  this  patient  himself:  as  it  contains  no  important  facts, 
I  have  omitted  it  here.  I  have,  however,  several  times  myself  exa- 
mined this  patient,  and  have  assured  myself  of  the  exactitude  of  the 
report. 

F had  carried  masturbation  to  such  an  extent,  that  he  passed 

aqueous  semen,  mixed  with  blood ;  the  seminal  vesicles  were  there- 
fore in  a  morbid  condition  when  he  left  off  the  habit.  A  fortnight 
afterwards,  he  noticed  a  deposit  in  his  urine,  which  he  had  never 
before  perceived,  and  which  continued  constantly  afterwards.  During 
four  years,  he  never  relapsed  into  his  former  habits,  and  he  was  not 
affected  by  nocturnal  emissions;  yet  he  continued  to  lose  flesh.  Im- 
mediately after  the  cauterization  he  became  convalescent.  Is  it  not 
evident,  that  the  absence  of  venereal  desires  and  of  nocturnal  emis- 
sions during  so  long  a  period,  was  owing  to  the  occurrence  of  invo- 
luntary diurnal  pollutions?  Is  there  any  other  mode  by  which  we 
can  explain  the  continued  disorder  of  the  patient's  health,  and  its 
sudden  restoration  ?     The  answer  is  evident. 

Whenever  F — —  fatigued  himself  more  than  usual,  the  urinary 
deposit  became  more  abundant.  This  may  appear  to  be  an  excep- 
tion to  the  usual  good  effects  which  patients  experience  from  pedes- 
trian exercise.  Everything  depends  on  the  strength  of  the  system, 
and  on  the  quantity  of  that  strength  expended.  Fatigue  is  as  hurt- 
ful in  such  cases,  as  exercise  is  beneficial. 


CASE  XXXII. 

Masturhation  from  twelve  to  twenty-two  years  of  age — Melanclwly — In- 
clination to  suicide — Serious  alteration  of  the  health — Monomania — 
Unperceived  diurnal  pollutions — Cauterization  followed  hy  "perfect  re- 
covery. 

At  the  beginning  of  April,  1836,  M.  Emile  Gr was  sent  to  consult 

me,  by  Dr.  Cauvi^re,  of  Marseilles.     He  was  twenty-five  years  of  age,  and 


132  CAUSES    OF    SPERMATORRHCEA. 

had  attracted  notice  from  the  brilliancy  of  his  intellect.  At  twenty-one 
vears  of  age,  he  had  been  admitted  an  advocate  in  a  highly  flattering  man- 
ner. 

He  stooped  much,  and  though  his  bony  system  seemed  to  announce  a 
strong  constitution,  his  limbs  were  small,  and  his  muscles  soft.  His  hair 
was  black  and  thin,  his  skin  was  pale,  and  his  face  without  expression. 
His  eyes  were  dull,  and  constantly  cast  down ;  his  voice  weak  and  husky  ; 
and  his  general  appearance  announced  great  timidity.  His  legs  were  con- 
stantly in  motion. 

I  learned  that  M.  Gr had  contracted  the   habit  of  masturbation   at 

school,  at  twelve  years  of  age;  and  that  whilst  studying  law  at  Paris,  at 
the  age  of  nineteen  he  found  a  change  in  his  character  commencing  :  this 
I  will  describe  in  his  own  words :  At  first  I  felt  a  gradually  increasing 
disgust  of  everything  and  a  constant  sense  of  ennui.  From  that  period  I 
only  saw  the  dark  side  of  life.  Thoughts  of  suicide  soon  afterwards  oc- 
curred to  me,  and  this  state  of  mind  continued  for  twelve  months,  after 
which  other  ideas  took  the  place  of  those  respecting  suicide.  I  considered 
myself  a  subject  of  ridicule,  and  fancied  that  the  expression  of  my  counte- 
nance, or  my  manner,  excited  an  insulting  gayety  in  the  persons  I  met. 
This  notion  each  day  acquired  new  strength,  and  often  when  in  the  street, 
or  even  when  at  my  own  house,  or  in  a  room  surrounded  by  my  relations 
and  friends,  I  fancied  I  heard  in.sults  which  were  aimed  at  me.  /  think  so 
iffiU.  At  length,  as  my  state  became  worse,  I  thought  that  every  one  in- 
sulted me,  and  I  still  think  so.  If  any  one  expectorates  or  blows  his  nose, 
coughs,  laughs,  or  puts  his  hands  or  his  handkerchief  before  his  face  in  my 
presence,  I  experience  the  most  painful  sensation.  Sometimes,  I  feel  en- 
raged, but  more  frequently  a  depression  of  spirits,  ending  in  involuntary 
tears.  I  look  at  no  one,  and  my  eyes  are  never  fixed  on  any  object. 
Wrapped  up  in  my  own  thoughts,  I  am  indifferent  to  all  external  impres- 
sions. These  signs  are  evidently  those  of  imbecility.  I  admit  that  I  may 
have  had,  and  that  I  may  even  now  have,  halliiciuations,  but  I  am  fully 
persuaded  that  these  ideas  are  not  without  foundation  :  1  am  convinced  that 
the  expression  of  my  countenance  has  something  strange  in  it,  that  people 
read  in  my  looks  the  fears  which  agitate,  and  the  ideas  which  torment  me, 
and  that  they  laugh  at  this  unhappy  weakness  of  intellect,  which  they  ought 
rather  to  pity. 

The  patient  experienced  a  sense  of  heaviness  and  oppression  in  his  head, 
and  although  fatigued  by  slight  exercise  was  constantly  in  motion.  Two 
years  before  he  consulted  me  he  began  to  correct  himself  by  degrees;  and 
for  nine  months  he  had  entirely  renounced  the  practice  of  masturbation, 
yet  notwithstanding  this,  his  state  daily  grew  worse.  His  digestion  was 
disordered;  he  suffered  from  obstinate  constipation;  and  his  erections  and 
venereal  desires  had  left  him  for  a  long  time.  Yet  he  did  not  mention  the 
last  facts  in  the  written  statement  of  his  case  which  he  sent  me;  they  were 
minor  evils;  one  idea  alone  absorbed  him — the  conviction  that  he  was  an 
object  of  contempt  and  ridicule  to  all  who  approached  him ;  this  idea  was 
aggravated  by  the  knowledge  of  his  impotence,  and  by  shame  for  the  cause 
which  had  produced  it. 

This  patient's  urine  usually  contained  an  abundant  flocculent  deposit, 
resembling  a  thick  decoction  of  barley;  it  decomposed  very  i-apidly,  and 
emitted  a  disagreeable  smell.  After  every  stool  the  point  of  the  glans  penis 
was  covered  with  a  clammy  viscid  matter,  resembling  a  thick  solution  of 
2um. 


ABUSE.  133 

These  circumstances  confirmed  me  in  the  idea  that  the  involuntary  seminal 
discharges  alone  opposed  the  patient's  recovery.  The  frequent  emission 
of  his  urine ;  the  sensibility  of  the  spermatic  cord,  of  the  testicles,  and 
especially  of  the  urethral  mucous  membrane,  and  the  injected  state  of  the 
orifice  of  the  urethra,  made  me  attribute  these  evacuations  to  irritation  of 
the  spermatic  organs  rather  than  to  their  relaxation. 

As,  however,  the  patient  refused  to  submit  to  cauterization,  I  ordered  him 
iced  milk  mixed  with  Spa  water,  cold  lotions,  &c. ;  but  he  found  himself 
much  worse  after  the  use  of  these  means ;  all  his  symptoms  were  aggra- 
vated ;  his  urine  became  thicker,  and  left  a  glairy  deposit  adhering  to  the 
bottom  of  the  vessel. 

At  length,  on  the  23d  of  April,  I  persuaded  M.  Gr to  submit  to  cau- 
terization, and  I  performed  it  immediately,  chiefly  on  the  neck  of  the  bladder 
and  the  prostatic  portion  of  the  urethra:  nothing  particular  occurred,  except 
that  the  inflammation  of  the  urethra,  which  followed  the  application,  was 
not  entirely  removed  for  three  weeks.  This,  I  believe,  arose,  in  a  great 
measure,  from  the  severe  weather  which  prevailed  at  the  time.  I  ordered 
two  or  three  warm  baths  to  be  taken  in  the  week,  an  a  few  warm  injections 
and  demulcent  drinks.  At  the  expiration  of  a  month,  the  patient  took 
pleasure  in  going  out,  and  occupied  himself  with  gardening  ;  he  felt  stronger, 
and  took  longer  walks ;  he  was  able  to  employ  himself  longer  without 
fatigue;  he  also  experienced  nocturnal  emissions,  preceded  by  erotic  dreams 
and  lively  sensations.  At  this  he  was  at  first  alarmed,  but  he  gained  cou- 
rage when  he  saw  that  he  was  not  injured  by  them.  I  had  not  seen  him 
for  more  than  a  month,  when  one  day  he  called  on  me  quite  dispirited,  to 
say  that  he  should  never  get  well,  as  he  was  relapsing  into  his  former  habits. 
I  blamed  him,  but  at  the  same  time  I  explained  to  him  that  the  fact  was  a 
proof  of  his  having  gained  his  former  virility,  of  which  he  should  make 

moie  proper  use.     M.  G 's  mother  came  to  me  soon  after  to  speak  of 

the  propriety  of  marriage  for  her  son,  whom  she  saw  exposed  to  various 
dangers.  I  easily  persuaded  her,  that  before  deciding  on  marriage,  it  would 
be  necessary  for  him  to  be  firmly  assured,  during  a  considerable  period,  of 

his  perfect  and  decided  recovery.     M.  G had  then  regained  his  spirits, 

his  boldness,  and  his  position  in  society,  and  eighteen  months  afterwards, 
all  his  functions  being  performed  with  energy,  he  married.  Six  months 
after  his  marriage  I  heard  that  his  health  had  not  for  a  moment  been  dis- 
ordered. 

With  this  patient  I  received  the  following  consultation  from  Dr. 
Esquirol.  "The  undersigned  cannot  mistake  a  case  of  ht/pochondriasis 
which  has  lasted  three  years.  It  is  evident  that  the  nervous  affection 
was  produced  by  the  habit  of  masturbation  to  which  the  patient  was 
addicted  from  the  age  of  puberty,  and  of  which  he  only  succeeded  in 
breaking  himself  seven  months  since.  The  hypochondriasis  continues 
very  obstinately,  as  the  cause  which  produced  it  acted  for  a  long  time, 
and  very  seriously  weakened  the  nervous  system.  The  undersigned 
attributes  the  little  success  attending  medical  treatment  to  the  unfa- 
vorable weather,  to  the  indocility  of  the  patient,  who  lives  in  seclu- 
sion and  in  physical  and  moral  torpor,  and  to  the  weakness  of  his 
mother,  who  allows  herself  to  be  led  away  by  the  sight  of  false  or 
exaggerated  sufferings.  The  means  advised  are  those  usually  ordered 
9 


134  CAUSES    OF    SPEEMATOREHffiA. 

in  cases  of  hypochondriasis  :  Tonics,  antispasmodics,  leeches  to  the 
anus,  purging,  change  of  scene,  travelling,  sulphuretted  baths,  sea- 
bathing," &c.  Dr.  Esquirol  sums  up  his  opinion,  in  concluding,  as 
follows  :  "  I  must  repeat  what  I  have  said  above:  weakened  innerva- 
tion is  the  cause  of  the  disease,  and  everything  which  can  strengthen 
the  nervous  system  will  be  useful."  It  was  clear  that  masturbation 
had  been  the  first  cause  of  the  physical  and  moral  derangement,  called 
hypochondriasis  ;  but  the  patient  had  renounced  this  vice  during  nine 
months,  and  his  state  became  worse  daily,  instead  of  improving.  It 
was  evident,  therefore,  that  some  other  cause  acted  in  keeping  up  the 
disorder  ;  and  it  was  just  as  evident  that  this  cause  was  involuntary 
diurnal  seminal  discharges.  It  is  not  necessary  for  me  to  show  that 
masturbation  can,  acting  alone,  induce  involuntary  discharges,  or  that 
the  cure  was  due  to  cauterization  only,  although  its  effects  were  not 
manifest  for  a  month  after  the  application  of  the  caustic ;  but  I  must 
insist  on  the  pathological  condition  of  the  genital  organs  exciting  these 
involuntary  evacuations,  since  they  have  been  too  frequently  ascribed 
to  a  state  of  debility  or  relaxation  of  the  tissues.  The  tonics  ordered 
by  Esquirol  had  produced  no  benefit :  I  have  described  the  symptoms 
which  led  me  to  suspect  acute  irritation  of  the  prostatic  portion  of 
the  urethra,  and  I  have  since  shown  the  injurious  effects  of  cold  lotions, 
iced  milk.  Spa  water,  &c.  It  was,  then,  not  by  causing  contraction 
of  the  orifices  of  the  ejaculatory  canals,  that  the  cauterization  pro- 
duced its  beneficial  effects,  but  by  dispersing  the  chronic  engorge- 
ment of  the  mucous  membrane.  The  advantage  derived  from  warm 
baths  during  convalescence  corroborates  this  opinion. 

In  M.  G 's  case  a  predominating  symptom  attracted  the  atten- 
tion of  the  practitioners ;  hence  they  looked  on  the  disease  as  being 
hypochondriasis,  monomania,  or  hallucination,  continuing  after  the 
cessation  of  its  exciting  cause,  and  becoming,  consequently,  an  idio- 
pathic affection.  I  have,  however,  shown  that  all  the  functions  had 
been  altered  more  or  less  ;  I  should  add,  that  the  digestion  was  the 
last  to  be  re-established  perfectly.  Such  mistakes  are  very  common, 
and  very  serious,  and  I  cannot  too  strongly  impress  their  importance 
on  the  attention  of  the  profession.  Esquirol  justly  stated  that  the 
hypochondriasis  took  its  origin  from  masturbation  ;  that  the  nervous 
system  was  weak  and  excited  ;  but  he  mistook  the  cause  which  kept 
up  this  condition  of  the  brain.  When  masturbation  has  not  induced 
involuntary  seminal  emissions,  recovery  soon  follows,  on  leaving  off 
the  habit  which  has  destroyed  the  health;  within  a  week  the  patients 
begin  to  experience  a  notable  improvement,  and  in  a  very  short  time 
they  are  hardly  recognizable,  whatever  may  have  been  the  degree  of 
weakness  to  which  they  were  reduced.     But  when  Dr.  Esquirol  wrote 

his  opinion,  seven  months  had  elapsed,  during  which  M.  G 's 

conduct  had  been  irreproachable,  and  when  I  saw  him  two  months 
later,  his  state  was  even  worse,  although  he  had  never  resumed  his 
former  habits.  The  symptoms  were,  however,  kept  up  by  involun- 
tary diurnal  discharges. 


ABUSE.  135 

The  effects  of  the  cauterization  were  very  conclusive,  and  as  soon 
as  its  curative  action  was  felt,  the  patient,  of  his  own  accord,  took 
various  kinds  of  exercise,  aud  sought  out  the  different  amusements, 
which  had  been,  in  vain,  ordered  for  him  previously;  he  entered  into 
society,  and  did,  without  being  pressed,  all  that  he  had  before  re- 
fused to  do  ;  his  ideas  and  his  necessities  altered  in  proportion  as 
Lis  functions  were  re-established. 

It  is  in  vain  that  we  say  to  the  so-called  hypochondriac — amuse 
yourself,  employ  your  mind,  go  into  society,  seek  agreeable  conver- 
sation ;  so  long  as  we  have  not  removed  the  cause  of  his  disorder,  he 
is  unable  to  profit  by  our  counsels.  How  can  we  expect  that  when 
a  man  is  fatigued  by  the  least  exercise,  he  shall  occupy  himself  with 
walking  or  gardening  ?  How  can  we  desire  him  to  go  into  society, 
when  the  simple  presence  of  a  woman  intimidates  him,  and  recalls  all 
his  former  misfortunes?  How  can  we  expect  him  to  enjoy  conversa- 
tion, when  he  loses  its  thread  every  moment  ?  When  his  memory 
leaves  him,  and  when  he  feels  his  nullity  ?  We  persuade  him  to 
seek  amusements  and  pleasures,  but  are  they  such  to  him  ?  Is  not 
the  happiness  of  others  his  greatest  punishment  ?  Because  he  is  una- 
ble to  follow  our  advice  we  accuse  him  of  unwillingness,  and  we  wish 
to  compel  him.  Let  us  first  remove  the  cause  of  our  patient's  dis- 
ease, and  we  shall  soon  see  that  his  character  and  conduct  will 
change,  and  that  he  will  return  to  his  natural  tastes  and  habits. 

It  is  not  long,  in  such  cases,  before  we  are  embarrassed  by  ques- 
tions about  the  propriety  of  marriage  being  put  to  us:  this  is  a  matter 
which  is  serious  in  all  its  aspects,  and  on  which  the  least  scrupulous 
should  not  pronounce,  without  having  had  sufficient  assurance  of 
their  patient's  return  to  health.  The  question  of  our  patient's  health 
is  now  not  the  only  one,  nor  is  even  his  future  happiness  alone  impli- 
cated ;  the  fate  of  the  innocent  being  who  is  about  to  be  associated 
with  him,  is  the  matter  of  chief  importance,  and  justice  to  her  de- 
mands that  we  do  not  counsel  matrimony,  until  sufficiently  long  proof 
has  been  given  that  our  patient's  re-establishment  is  permanent. 

CASE  XXXIII. 

Abuse  caused  hy  sleeping  on  the  helly — Effects  of  reading  erotic  vjorks — 
Putoer  of  habit — Alteration  of  the  intel/ectucd  and  moral  faculties — Im- 
potence—  Chronic  Irritation  of  the  bladder — Xocturnal  and  diurnal  pol- 
lutions—  Cauterization  folloiced  by  prompt  recovery. 

Eugene  C ,  at  seven  years  of  age,  was  strong  and  healthy,  but  about 

this  period  he  contracted  the  habit  of  lying  on  bis  belly  at  night.  In  this 
position  the  genital  organs  were  heated  during  sleep,  and  the  penis  became 
erect,  although  the  boy  did  not  present  the  least  sign  of  puberty.  Pressure 
against  the  bed  produced  titillation,  and  induced  a  habit  of  abuse,  as  in- 
jurious in  its  effects  as  masturbation.  The  child  was  perfectly  free  from 
any  sexual  feelings,  and  had  never  been  exposed  to  the  influence  of  bad 
example ;  besides  which,  he  was  naturally  modest  and  reserved.     The  first 


136  CAUSES    OF    SPERMATOREH(EA. 

impression  was,  therefore,  quite  instinctive  and  accidental,  but  the  habit 
was  soon  confirmed  into  an  irresistible  passion. 

Between  the  ages  of  nine  and  eleven  the  child's  character  changed ;  he 
became  restless  and  quarrelsome,  but  his  intellectual  faculties  were  active, 
and  he  was  able  to  keep  up  with  his  companions  in  their  studies,  and  to  make 
himself  feared  by  them,  on  account  of  his  quarrelsome  disposition.  Be- 
tween the  ages  of  eleven  and  thirteen,  however,  he  yielded  to  the  practice, 
two  or  three  times  a  night,  and  became  idle,  timid,  and  weak ;  he  fell  behind 
his  fellow  students  in  his  studies  ;  and  though  he  was  easily  provoked  to 
quarrel,  he  found  himself  always  beaten.  On  this  account  he  sought  soli- 
tude. At  the  age  of  fourteen,  the  habit  he  had  contracted  was  temporarily 
broken  oif,  by  his  brother's  sleeping  with  him  ;  but  at  the  expiration  of 
three  months,  when  left  to  himself,  he  relapsed.  At  the  age  of  fifteen,  a 
remonstrance  received  before  his  fellow  students  by  one  of  his  masters, 
caused  him  to  abstain  during  eight  months ;  he  regained  his  strength,  his 
character  altered,  and  he  made  up  for  the  time  he  had  lost  in  his  studies. 

At  the  end  of  the  year  he  even  wrote  so  remarkable  an  essay  at  the  com- 
petition for  prizes,  that  he  was  supposed  to  have  copied  it.  On  this  account, 
at  another  competition  some  time  afterwards,  he  was  separated  from  his 
companions,  and  carefully  watched.  In  the  mean  time,  however,  some 
obscene  books  had  fallen  in  his  way,  and  excited  his  imagination.  He  re- 
sumed his  habits  with  fury,  and  when  the  day  of  competition  arrived,  his 
condition  had  become  worse  than  ever.  He  passed  all  the  time  allowed  for 
the  trial  in  a  state  of  febrile  excitement,  without  writing  a  word.  Some 
time  afterwards,  he  made  a  strong  resolution  to  correct  himself,  but  the  habit 
had  become  so  strong,  that  he  often  had  recourse  to  it,  unconsciously,  dur- 
ing sleep.  By  degrees,  however,  he  corrected  himself,  but  very  frequent 
nocturnal  pollutions  supervened,  and  destroyed  all  the  benefit  that  arose 
from  the  change. 

At  the  age  of  seventeen  the  patient  came  to  Montpellier  to  obtain  the 
degree  of  bachelor  of  letters  :  the  state  of  his  intellectual  faculties  prevented 
this ;  indeed,  out  of  ten  hours  spent  in  his  study,  nine  were  passed  in  think- 
ing of  his  condition,  and  of  the  different  means  by  which  ho  could  commit 
suicide.  He  attempted  sexual  intercourse,  but  found  himself  quite  impo- 
tent. Horse  exercise,  and  the  various  tonics  and  stimulants  which  were 
prescribed  for  him,  only  increased  his  disorder. 

I  need  not  relate  all  the  functional  derangements  which  the  patient  un- 
derwent ;  but  it  is  necessary  that  I  should  notice  a  chronic  inflammation  of 
the  bladder,  of  which  the  cause  was  unknown,  and  diurnal  pollutions,  which 
he  did  not  discover,  although  they  were  much  more  serious  than  the  noc- 
turnal emissions  which  had  become  more  and  more  rare  during  the  previous 
twelve  months. 

About  the  end  of  November,  1836,  I  cauterized  the  neck  of  the  bladder, 
and  the  prostatic  portion  of  the  urethra.  Fifteen  days  afterwards,  the  pa- 
tient was  better,  and  he  immediately  went  into  the  country,  where  his  cure 
was  soon  confirmed. 

M.   C has  since   studied   medicine   with    much    energy ;  and  has 

passed  the  examinations  of  B.  L.  and  B.  A.  with  credit.  His  character 
has  become  frank  and  kind,  and  it  is  evident  that  he  is  in  good  health  and 
spirits. 

This  case  shows  the  importance  of  the  apparent  trifles  that  occur  in 


ABUSE.  137 

childhood,  and  at  the  period  of  puberty  ;  and  the  serious  effects  which 
a  slight  neglect  of  them  may  produce  during  the  whole  of  after  life. 

CASE  XXXIV. 

Sexual  ideas  at  the  age  of  eight— Abuse  at  thirteen — Various  diseases  in 
consequence,  until  the  age  of  thirty-two — Nocturnal  and  diurnal  pollutions 
—  Cauterization — Slow,  hut  progressive  improvement. 

M.  A ,  when  a  child,  was  remarkable  for  precocity  of  intellect ;  but 

was  troubled  with  worms  during  the  early  years  of  his  life.  Being  allowed 
to  sleep  with  his  governess,  when  about  eight  years  of  age,  he  remarked 
differences  of  form,  which  he  had  never  before  seen.  His  active  imagina- 
tion dwelt  on  these  incessantly,  and  at  length  he  fell  into  a  state  of  melan- 
choly, of  which  the  cause  was  far  from  being  suspected.  At  the  age  of 
thirteen,  a  young  female  took  advantage  of  him,  but  without  permitting 
intromission.  Shortly  afterwards,  when  at  school,  these  circumstances 
constantly  recurred  to  his  imagination,  and  during  the  night  he  took  care 
to  place  himself  as  much  as  possible  in  the  same  position,  in  order  to  renew 
the  same  sensations.  He  thus  contracted  a  habit  quite  as  injurious  as 
masturbation.  His  health  became  affected,  even  before  any  seminal  emis- 
sion had  taken  place ;  his  growth  was  arrested ;  his  sight,  memory,  and 
intellect,  became  weak.  At  the  age  of  seventeen,  emissions  occurred  during 
defecation,  and  were  followed  by  a  diminution  of  the  patient's  erections  and 
venereal  desires,  as  well  as  of  his  abuses.  At  nineteen  years  of  age,  he  had 
a  chronic  gastritis,  headache,  pain  in  the  hypochondriac  regions,  and  noc- 
turnal pollutions.  For  these  symptoms,  a  milk  diet  was  prescribed,  and 
adhered  to  for  a  year,  together  with  baths,  enemata,  and  country  exercise. 
At  the  age  of  twenty-two,  chronic  gastro- enteritis  supervened,  and  was  fol- 
lowed by  inflammation  of  the  bladder,  which  passed  into  a  state  of  chronic 
vesical  catarrh.  After  about  two  years,  the  patient's  health  was  restored. 
By  degrees,  his  old  habits  and  nocturnal  pollutions  returned,  and  induced 
a  new  derangement  of  his  health ;  at  the  age  of  twenty-five,  chronic  inflam- 
mation of  the  digestive  organs  and  bladder  again  appeared,  but  was  re- 
lieved by  emollients  and  a  severe  regimen.  About  the  age  of  twenty-eight, 
his  health  partially  returned,  but  his  sleep  continued  heavy  and  unrefresh- 
ing,  and  was  often  interrupted.  At  thirty,  his  digestion  was  much  disor- 
dered ;  constipation  and  diarrhoea  occurring  alternately. 

The  patient's  condition  gradually  became  worse,  until  he  came  to  Mont- 
pellier,  in  February,  1836.  He  was  then  thirty-two  years  of  age,  and  pre- 
sented the  following  symptoms  :  appearance,  sad,  restless,  and  timid ;  legs 
weak :  constant  restlessness ;  feeling  of  icy  coldness  in  the  thighs  ;  lower 
part  of  the  belly,  and  genital  organs ;  appetite  capricious ;  digestion  labori- 
ous, and  accompanied  with  discharge  of  flatus ;  memory  treacherous ;  dis- 
like of  society;  irritability  of  temper;  overruling  egotism;  constant  pre- 
sence of  lascivious  ideas,  contrasting  strongly  with  the  weakness  of  the 
genital  organs ;  mental  debility;  sleep  broken,  and  unrefreshing;  frightful 
dreams ;  frequent  desire  to  micturate,  especially  during  the  night ;  urine 
thick  and  muddy,  generally  presenting  an  abundant  flocculent  precipitate, 
and  giving  off  a  disagreeable  smell ;  genital  organs  very  little  developed ; 
prepuce  long ;  and  testicles  small. 

After  observing  the  patient  for  several  days,  I  cauterized  the  bladder  and 


138  CAUSES    OF    SPEEMATOEEH(EA. 

prostatic  portion  of  the  urethra ;  the  operation  was  followed  by  a  more  in- 
tense inflammation  than  usual,  probably  due  to  the  bad  weather.  As  soon 
as  he  was  able,  the  patient  quitted  Montpellier,  to  return  home. 

Not  having  heard  from  him,  I  augured  that  the  cauterization  had  been 
unsuccessful,  when  one  day,  several  months  afterwards,  as  I  w'as  passing 

throuf^h  Lyons,  I  was  accosted  by  M.  A ,  who  was  so  changed  that  I 

hardly  recognized  him.  He  stated  that  a  slow,  but  progressive  improve- 
ment had  taken  place  after  his  leaving  Montpellier ;  the  pollutions  he  had 
before  experienced  during  defecation  disappeared  ;  his  ui-ine  became  clear, 
and  was  passed  less  often  and  less  suddenly ;  nocturnal  pollutions  occurred 
seldom,  and  his  erections  became  energetic. 

The  abuses  practised  on  the  genital  organs  had  the  same  cha- 
racter in  this  as  in  the  preceding  case  ;  and  in  both,  they  produced 
the  same  effects  as  masturbation.  We  observe  in  the  last  case, 
that  sexual  ideas  preceded  for  a  long  time  the  development  of  the 
sexual  organs ;  and  that  the  venereal  desires  had  no  relation  what- 
ever to  the  amount  of  development  of  the  generative  organs. 

The  influence  of  a  premature  liaison  on  these  abuses  is  also 
worthy  of  notice.  The  remembrance  of  such  irregular  and  prema- 
ture enjoyments  constantly  presented  itself  before  the  patient's  im- 
agination, and  caused  his  frequent  relapses.  The  habit  at  length 
overcame  the  will,  and  even  took  its  place,  provoking  the  same  acts 
during  sleep.  The  power  of  habit  was  just  the  same  as  in  the  pre- 
ceding case. 

At  the  age  of  seventeen,  M.  A noticed  that  he  passed  semen 

while  at  stool ;  he  had,  therefore,  thus  early,  diurnal  pollutions.  He 
did  not  pay  attention  to  these,  because  he  was  not  aware  of  their 
importance ;  but  it  is  evidently  to  the  occurrence  of  such  discharges 
that  we  must  attribute  the  feebleness  of  his  erections,  the  impossi- 
bility of  coitus,  and  the  long  series  of  sufferings  he  afterwards  en- 
dured. 

As   to  the  other  symptoms  presented  by  M.  A ,  I  need  not 

enter  into  their  consideration — I  have  already  done  so  several  times 
— such  symptoms  being  common  to  all  cases  of  spermatorrhoea. 

Were  the  discharges  in  this  case  due  to  a  state  of  atony  ?  This 
would  seem  to  be  the  case,  if  we  only  regarded  the  small  develop- 
ment of  the  organs,  and  the  habitual  weakness  of  the  erections ;  but 
the  acute  attack  of  cystitis,  and  the  chronic  catarrh  of  the  bladder, 
showed  clearly  enough,  that  the  seminal  vesicles  and  ejaculatory 
canals  must  have  been  also  in  a  state  of  irritation.  •The  curative 
effects  of  cauterization  were  postponed  for  a  considerable  time,  so 
that  I  almost  despaired  of  benefit  from  the  operation  ;  yet,  no  other 
treatment  having  been  employed,  the  improvement  was  evidently 
due  to  the  cauterization  alone.  In  case  thirty-two,  I  have  already 
noticed  the  same  circumstance,  and  it  is  worthy  of  remark,  that 
both  these  cases  were  operated  on  during  a  very  wet  and  cold  sea- 
son. Whether  this  be  the  correct  explanation  or  not,  such  cases 
are  not  rare,  and  I  -wish  particularly  to  point  them  out,  because  I 


ABUSE.  139 

have  met  with  many  patients  affected  with  spermatorrhoea,  who  had 
been  cauterized  three,  four,  or  five  times,  or  even  still  more  often, 
in  the  space  of  a  month.  This  subject  I  shall  treat  fully,  when 
speaking  of  the  treatment  of  spermatorrhoea. 


CASE   XXXV. 

Masturbation  at  sixteen  years  of  age — At  twenty-one,  compression  of  the 
urethra  (luring  ejaculation,  followed  hy  a  sensation  of  tearing,  and  acute 
pain  —  Urethral  discharge  recurring  frequently — Discharges  of  semen 
during  defecation  and  the  emission  of  urine — Reciprocal  influence  of 
these  discharges  on  the  digestive  organs — Chronic  catarrh  of  the  bladder 
—  Cauterization — Recovery  after  several  relapses. 

M.  G ,  of  sanguineous  temperament,  and  robust  constitution,  con- 
tracted the  habit  of  masturbation  when  about  sixteen  years  old.  The  fol- 
lowing year,  he  was  troubled  with  disordered  digestion,  oppression,  and 
difl&culty  of  respiration.  At  the  age  of  twenty-one,  he  determined  to  con- 
quer bis  propensity,  but  after  a  few  days'  continuance,  he  relapsed,  in  conse- 
quence of  the  violent  erections  he  experienced.  During  this  contest  between 
his  will  and  his  passion,  be  one  day  compressed  the  urethra  forcibly,  when 
on  the  point  of  ejaculation.  On  the  instant,  he  experienced  a  sensation  of 
tearing  in  the  interior  of  the  canal,  followed  by  acute  pain,  which  afterwards 
frequently  returned ;  the  following  day,  after  an  erection,  he  felt  the  glans 
wet,  and  found  the  orifice  of  the  urethra  filled  with  a  viscid  matter,  resem- 
bling a  very  thick  solution  of  gum.  From  that  time,  this  kind  of  discharge 
always  continued,  varying  only  a  little  in  appearance  and  quantity,  according 
to  circumstances;  the  patient's  erections  became  less  energetic,  and  the 
sensations  produced  by  ejaculation  grew  progressively  weaker  :  at  the  same 
time,  the  functions  of  his  stomach  were  disordered  and  frequent  attacks  of 
indigestion  took  place.  At  the  end  of  two  years,  the  urethral  discharge 
increased  suddenly  after  coitus;  at  the  same  time  assuming  a  blennorrhagic 
appearance.  This  was  treated  by  emollients  and  copaiba,  and  at  the  end 
of  three  months,  the  former  state  returned ;  the  discharge  was  easily  in- 
creased however,  by  the  least  error  of  diet,  as  well  as  by  very  slight  venereal 
excitement.  The  patient's  erections  now  became  less  energetic  and  incom- 
plete ;  and,  on  the  other  band,  his  digestion  was  more  and  more  disordered 
and  accompanied  with  colic,  flatulence,  and  constipation — the  efforts  at  stool 
giving  rise  to  seminal  discharge.  Various  remedial  means  were  adopted 
but  without  success.  At  the  age  of  twenty-eight,  the  patient,  after  a  slight 
error  of  diet,  experienced  an  exacerbation  of  all  bis  symptoms,  and  in  addi- 
tion, his  urine  became  thick,  muddy,  and  fetid,  and  its  discharge  very  fre- 
quent, and  accompanied  by  an  acute  pain  at  the  root  of  the  penis,  and  in 
the  bladder.  In  this  state  the  patient  came  to  Montpellier,  on  the  19th  of 
April,  1826,  being  then  about  thirty.  After  observing  him  for  several  days, 
I  noticed  that  his  urine  was  constantly  muddy  and  fetid,  and  contained  a 
red  sediment,  which  adhered  to  the  sides  of  the  vessel,  and  a  thick  and 
flocculent  deposit,  which  fell  to  the  bottom  ;  a  slightly  opaque  cloud  occu- 
pying the  upper  part,  while  on  the  surface  a  thin  iridescent  pellicle  floated. 
The  urethral  mucous  membrane  was  also  very  irritable,  especially  towards 
the  neck  of  the  bladder.     On  the  2d  of  May,  I  slightly  cauterized  the  bladder 


140  CAUSES    OF   SPEEMATOERHCEA. 

near  its  neck,  and  more  severely  the  prostatic  portion  of  the  urethra,  closing 
the  instrument  before  it  reached  the  bulb.  The  operation  produced  its 
usual  effects.  Five  days  afterwards,  the  urine  no  longer  contained  blood, 
and  within  fifteen  days  it  was  passed  without  pain  or  inconvenience.  A 
month  after  the  operation  the  urine  was  quite  clear,  the  digestive  organs 
had  regained  their  energy,  and  the  patient  was  able  to  eat  heartily  without 
being  inconvenienced.  His  stools  became  regular,  and  were  passed  easily; 
the  seminal  discharges  diminished;  his  strength  returned  and  allowed  him 
to  take  long  walks,  and  his  sleep  became  sound  and  refreshing.     In  this 

state  of  convalescence  M.  G left  Montpellier,  about  six  weeks  after  the 

cauterization. 

Five  months  afterwards,  I  received  a  letter  from  M.  G in  which  he 

stated  that  his  recovery  had  proceeded  by  degrees,  and  that  his  health  had 
been  excellent  during  three  months,  when  he  had  eaten  a  large  Cjiaantity  of 
grapes,  some  of  which  were  not  ripe  ;  a  severe  attack  of  indigestion  resulted, 
after  which  his  old  symptoms  returned,  and  strangely  enough,  he  felt,  during 
the  emission  of  urine,  a  sensation  in  the  prostatic  portion  of  the  urethra  re- 
sembling that  produced  by  the  application  of  caustic.  He  had  scarcely  re- 
covered from  his  relapse,  when  he  a  second  time  committed  an  error  in  diet, 
which  brought  on  a  more  serious  indigestion  than  the  first,  and  was  followed 

by  an  aggravation  of  all  his  former  symptoms.     In  this  condition  M.  G 

wrote  for  advice.  Four  months  afterwards,  I  received  another  letter  from 
him,  stating,  that  before  he  had  received  my  previous  answer  he  had  en- 
tirely recovered ;  but  that,  forgetful  of  the  past,  he  had  suffered  from  ano- 
ther indigestion,  with  another  slight  attack  of  his  former  symptoms.  I  in- 
sisted on  the  necessity  of  strict  diet,  and  further  recommended  a  trial  of  the 
sulphureous  waters  of  the  Pyrenees.  As  I  have  not  since  heard  from  this 
patient,  I  am  warranted  in  supposing  that  his  health  is  at  length  perma- 
nently established. 

This  case  shows  us  the  dangers  which  may  arise  from  an  impru- 
dent compression  of  the  urethral  canal  during  the  ejaculatory  or- 
gasm. Such  attempts  have  been  made  for  various  reasons — some- 
times in  the  hope  of  preventing  a  nocturnal  pollution — and  they  are 
generally  followed  by  the  same  result. 

At  the  moment  of  emission  a  kind  of  tearing  of  the  canal  takes 
place  ;  this  is  attended  with  acute  pain,  and,  in  the  case  before  us, 
was  followed  by  a  mucous  discharge,  which  continued  nearly  ten 
years. 

The  patient,  as  well  as  the  different  surgeons  who  attended  him, 
regarded  his  discharge  as  spermatic,  because  it  was  increased  by  ve- 
nereal excitement,  and  because  the  patient's  virility  constantly  dimi- 
nished, at  the  same  time  that  the  general  symptoms  of  spermatorrhoea 
were  present.  But  the  circumstances  which  preceded  the  discharge 
were  sufficient  to  show  that  it  arose  from  the  mucous  follicles,  inflamed 
or  irritated  by  a  laceration  at  some  point  of  the  passage.  Was  it 
astonishing,  then,  that  every  excitement  of  the  organs  should  have 
increased  this  discharge  ?  The  blennorrhagic  character  which  it  pre- 
sented for  some  time  proves,  even  still  more  certainly,  that  the  dis- 
charge was    not  spermatic.     The  changes  that  took  place  in  the 


ABUSE.  Ml 

patient's  health,  and  in  his  generative  functions,  are  explainer!  by 
the  occurrence  of  diurnal  pollutions,  both  during  defecation  and  the 
emission  of  urine  ;  and  the  occurrence  of  these  diurnal  pollutions 
after  chronic  inflammation  of  the  urethra  is  easily  explained,  by  re- 
ferring to  the  tendency  of  irritation  to  extend  from  the  prostatic 
mucous  membrane  to  the  adjacent  tissues. 

In  consequence  of  this  disposition,  the  urinary  organs  presented 
well  marked  symptoms  of  chronic  inflammation,  and  the  state  of 
these  gives  a  good  idea  of  what  was  going  on  in  the  spermatic  or- 
gans. 

We  must  conclude,  then,  that  the  constant  discharge  from  the 
canal  was  only  an  ordinary  blennorrhoea,  and  that  the  patient's  im- 
potence, and  the  derangement  of  his  health,  are  to  be  attributed 
solely  to  the  spermatic  discharges  which  took  place  during  defeca- 
tion and  the  emission  of  urine. 

I  have  attached  considerable  importance  to  the  right  understanding 
this  fact,  because  attacks  of  blennorrhagia  are  often  complicated  with 
diurnal  pollutions,  and  this  frequent  coincidence  has  caused  the  utmost 
confusion  in  the  opinions  given  on  the  subject,  since  Aretoaus  first 
spoke  of  a  constant  seminal  discharge.  It  is  at  once  evident,  that 
the  semen  being  contained  in  distinct  reservoirs  cannot  constantly 
run  off"  like  the  secretion  of  the  open  mucous  follicles.  I  shall  examine 
this  simple  question  more  fully  in  a  future  chapter,  but,  as  I  proceed, 
I  shall  show,  as  opportunities  occur,  that  the  symptoms  attributed 
to  these  constant  discharges  arise  really  from  unsuspected  pollu- 
tions happening  during  defecation  and  the  emission  of  the  urine. 

Another  result  of  this  easy  extension  of  irritation  from  the  prostate 
to  the  adjacent  mucous  membrane  in  the  case  under  consideration, 
was  the  chronic  afi'ection  of  the  bladder,  and  probably  also  of  the 
kidneys.  I  mention  this  circumstance  here,  to  show  how  diSicult 
all  these  complications  render  the  diagnosis  of  diurnal  pollutions. 
The  urine  contained  an  abundant  lithic  acid  deposit,  and  was  covered 
by  an  iridescent  pellicle ;  it  was  also  muddy  from  the  presence  of  a 
large  quantity  of  mucus,  a  thicker  deposit  occupying  the  lower  por- 
tion of  the  fluid.  The  abundance  of  salts  contained  in  the  secretion 
arose  from  the  irritation  of  the  kidneys;  the  bladder  and  the  prostate 
furnished  the  greater  part  of  the  other  matters ;  but  did  the  urine 
contain  semen  ?  I  believe  that  neither  chemical  analysis,  nor  mi- 
croscopical research,  would  have  been  able  to  decide  this  point. 

The  last  drops  of  urine  emitted  were  of  the  viscid  consistence  of 
a  solution  of  gum  or  starch,  and  this  matter  could  only  be  semen. 

It  is  unfortunate  that  these  complicated  cases  should  be  the  most 
common,  as  well  as  the  most  serious.  But  of  what  importance  to 
the  practitioner  is  the  existence  of  blennorrhagia,  or  the  mixture  of 
vesical  mucus,  of  prostatic  fluid,  or  of  different  salts,  with  the  urine  ? 
It  is  not  from  one  symptom  only,  that  he  should  judge  of  the  disease, 
but  from  the  whole.  The  most  important  point  in  these  embarrass- 
ing cases,  is  to  understand  fully  the  cause  and  connection  of  such 


142  CAUSES    OF    SPERMATOEEHGEA. 

complications,  in  order  to  ascertain  a  means  of  cure.  Happily,  the 
same  treatment  is  suited  to  all  the  symptoms,  because  they  all  de- 
pend on  the  same  cause.  In  this  case,  for  example,  the  cauteriza- 
tion put  a  stop  at  the  same  time  to  the  blennorrhoea,  the  chronic 
affection  of  the  bladder,  and  the  diurnal  pollutions — diseases  that 
had  existed  nine  or  ten  years. 

I  may  remark,  in  passing,  that  the  curative  effects  of  cauterization 
did  not'show  themselves,  in  this  case,  until  a  month  had  elapsed  ;  and 
that  from  this  time  they  progressed  slowly,  but  steadily,  so  that  the 
recovery  was  complete  at  the  end  of  three  months.  This  shows  the 
impropriety  of  repeating  the  use  of  caustic  without  waiting  to  see 
the  effects  of  the  operation. 

Two  remarkable  features  in  the  case  were,  the  influence  exer- 
cised by  the  spermatorrhoea  over  the  digestive  organs,  and  the  effect 
which  disordered  digestion  produced  on  the  genital  organs.  The 
stomach  was  the  organ  which  first  suffered  from  the  masturbation  ; 
and  which,  afterwards,  was  chiefly  affected  by  the  spermatorrhoea  ; 
whilst,  on  the  other  hand,  a  violent  indigestion  much  increased  the 
severity  of  the  symptoms ;  and  at  a  later  period,  when  the  cure 
seemed  perfectly  established,  four  attacks  of  indigestion  were  fol- 
lowed by  an  equal  number  of  more  or  less  serious  relapses,  and  by 
diurnal  pollutions,  and  irritation  of  the  bladder,  with  pain  in  the 
urethra,  resembling  that  caused  by  cauterization.  But  I  shall  re- 
sume the  consideration  of  this  sympathy  between  the  generative 
and  digestive  organs  when  speaking  of  the  symptoms  and  treatment 
of  spermatorrhoea. 

The  cases  which  I  have  related — few  in  number,  but  circum- 
stantial and  varied — are  sufficient  to  give  an  idea  of  the  principal 
abuses  of  which  the  generative  organs  are  the  seat,  and  of  the  man- 
ner in  which  such  abuses  bring  about  more  or  less  serious  and  re- 
sisting spermatorrhcea.  Of  all  the  causes  capable  of  producing 
this  unfortunate  result,  none  is,  at  present,  more  common.  I  ought, 
perhaps,  only  to  consider  here  the  mode  by  which  abuses  act  in 
producing  spermatorrhoea,  such  being  the  object  of  this  chapter  ; 
but  the  complicated  chain  of  circumstances  attaching  to  the  subject, 
forbids  this  ;  and  I  must  ascend  by  degrees  to  the  causes  of  the 
abuses,  in  order  that  they  may  be  avoided,  or,  at  least,  that  their 
danger  may  be  diminished.  Of  such  an  occurrence  it  is  especially 
of  importance  to  prevent  the  evil,  inasmuch  as,  when  once  esta- 
blished, it  is  occasionally  without  remedy,  and  generally  leaves  its 
traces  during  the  rest  of  the  patient's  life.  There  is,  perhaps,  no 
single  question  of  more  importance  to  the  happiness  of  families,  or 
to  the  welfare  of  society,  than  this.  In  order,  then,  to  examine 
the  numerous  facts  I  have  collected  in  their  proper  order,  I  shall 
first  speak  briefly  of  the  causes  of  abuse. 

Causes  of  Abuse.  —  These  may  be  divided  into  two  classes : 
First,  causes  inherent  in  man,  or  those  acting  from  within  ;  these 
may    be    considered    as    predisposing    causes;    secondly,    external 


ABUSE.  143 

causes,  or  those  arising  from  accidental  circumstances  ;  and  these 
may  be  considered  as  exciting  causes. 

Internal  or  Predisposing  Causes. — Of  the  first  class  of  causes,  the 
most  important  is  undoubtedly  due  to  the  human  organization.  In 
the  lower  animals  the  male  and  female  live  together,  as  if  there  were 
no  difference  of  sex,  except  during  the  short  rutting  season.  This 
period  passed,  perfect  calm  is  restored.  In  the  human  species,  the 
secretion  of  semen  constantly  goes  on,  from  the  time  of  maturity 
until  extreme  old  age  ;  the  secretion  may  indeed  be  increased  or 
diminished  by  excitement  or  repose  of  the  organs,  but,  during  this 
period,  it  is  never  entirely  suspended  as  long  as  the  secreting  tissues 
are  healthy.  Still,  this  universal  and  important  fact  has  been  much 
neglected  :  its  application  is  evident. 

The  form  of  the  superior  extremities  in  the  human  race  also  pos- 
sesses considerable  influence  in  predisposing  to  abuse.  Many  animals 
are  always  fit  for  fecundation — spermatozoa  being  found  in  them  at 
all  seasons.  They  are,  however,  unable  to  excite  seminal  emissions 
without  the  aid  of  the  female.  Other  animals,  again,  which,  during 
the  rutting  season,  show  an  almost  incredible  amount  of  erotic  fury, 
are  still  unable,  by  their  own  actions,  to  cause  spermatic  discharge  ; 
their  form  alone  prevents  this,  for  they  often  attempt  it,  and  a  few 
even  succeed.  It  is  well  known  with  what  fury  apes  are  addicted  to 
masturbation  ;  the  ape  being,  of  all  the  lower  animals,  the  nearest  to  ' 
man  in  form. 

To  this  original  disposition,  more  perfect  in  man  than  in  any  other 
animal,  must  be  added  the  influence  of  pathological  causes.  I 
have  already  spoken  of  the  irritation  caused  by  ascarides  in  the  rec- 
tum, of  the  erections  they  excite,  and  of  the  abuses  induced  by  them. 
We  shall  see,  by  and  by,  that  herpetic  eruptions  on  the  penis  and 
prepuce  may  produce  the  same  effects,  and  I  shall  show,  also,  that 
an  accumulation  of  sebaceous  matter  between  the  prepuce  and  glans 
may  have  a  similar  influence.  I  must  also  mention  irritation  of  the 
cerebellum,  as  inducing  serious  abuses,  of  which  I  shall  give  cases  in 
their  proper  place. 

There  is  even  some  connection  between  the  organs  of  generation 
and  distant  diseases  ;  for  Dr.  Desportes  has  mentioned  a  kind  of 
angina,  which  is  frequently  preceded  by  a  considerable  increase  in 
the  venereal  desires,  and  consequently  by  a  disposition  to  all  kinds 
of  abuses. 

Pulmonary  phthisis,  also,  is  often  attended  by  considerable  vene- 
real excitement.  It  may  as  well,  then,  be  at  once  admitted,  that 
causes  predisposing  to  masturbation  exist  in  the  human  organization 
itself. 

External  or  Exciting  Causes. — Of  these,  I  shall  lay  particular  stress 
on  such  as  act  before  puberty,  because  they  have  hitherto  attracted 
very  little  attention.  The  most  anxious  parents  believe  that  there  is 
no  occasion  to  watch  over  the  actions  of  their  children  with  regard  to 
their  genital  organs,  previously  to  the  epoch  of  puberty  ;  and  few, 


144  CAUSES    OF    SPERMATORRHOEA. 

even  of  our  own  profession,  are  led  to  suspect  bad  habits  before  that 
period.  This  is  a  fatal  error,  against  which  it  is  necessary  to  be  on 
our  guard  :  numerous  causes  may  give  rise  to  abuses,  at  a  much  ear- 
lier period — infancy  being  hardly  exempt  from  them.  I  saw  one 
unfortunate  child,  which,  while  still  at  the  breast,  nearly  fell  a  victim 
to  the  stupidity  of  its  nurse.  She  had  remarked,  that  handling  the 
genital  organs  appeased  its  cries,  and  induced  sleep  more  easily  than 
any  other  means,  and  she  repeated  these  manoeuvres,  without  no- 
ticing that  the  sleep  was  preceded  by  spasmodic  movements.  These 
increased,  and  took  on  a  convulsive  character,  and  the  child  was 
losing  flesh  rapidly,  and  becoming  daily  more  irritable,  when  I  was 
consulted.  At  first  I  attributed  the  disorder  to  Avorms,  teething,  &c., 
but  my  attention  being  attracted  by  certain  signs,  I  examined  the 
genital  organs,  and  found  the  penis  erect.  I  was  soon  told  all,  for 
the  nurse  had  no  idea  she  was  doing  wrong.  It  was  necessary  to 
dismiss  her,  for  her  presence  alone  sufiiced  to  recall  to  the  child's 
memory  sensations  which  had  already  become  a  habit.  Time  and 
strict  watching  were  required  before  these  early  impressions  were 
entirely  effaced,  Dr,  Deslandes  relates  two  similar  cases,  and  Pro- 
fessor Halle,  in  his  lectures  on  hygiene,  used  to  mention  many  such  ; 
Chaussier,  too,  has  told  me  of  several  that  came  under  his  notice  ;  and 
both  these  observers  believed  such  cases  to  be  less  rare  than  they  are 
usually  considered.  These  manoeuvres  quiet  the  children  very  rea- 
dily, and  nurses  always  endeavor  to  obtain  quiet  at  any  sacrifice  ; 
they  have  no  idea  of  the  consequences  of  their  conduct.  At  a  later 
period,  children  are  exposed  to  the  same  dangers,  on  the  part  of  the 
servants  having  charge  of  them  ;  and  in  these  cases,  it  is  not  of  igno- 
rance that  the  attendants  are  to  be  accused.  Many  patients  have 
consulted  me,  who  owed  their  disorders  to  this  cause  ;  and  in  case 
61,  I  have  shown  the  influence  which  such  early  abuse  exerts  on  after 
life.  In  some  children  there  is  a  kind  of  precocity  of  sexual  instinct, 
which  leads  to  very  serious  results.  In  these,  it  often  happens  that 
the  sexual  instinct  arises  long  before  puberty  ;  such  children  manifest 
an  instinctive  attraction  towards  the  female  sex,  which  they  show  by 
constantly  spying  after  their  nurses,  chambermaids,  &;c.  These  freaks 
of  children  are  usually  laughed  at ;  but  if  they  were  regarded  with 
more  attention,  it  would  become  evident  that  the  sexual  impulse  has 
been  already  awakened.  Rousseau,  in  his  confessions,  has  well 
described  the  influence  which  early  sexual  impulse  exercised  on  his 
whole  life,  and  I  have  received  numerous  confidences  of  the  same 
nature,  which,  however,  it  would  be  of  no  service  to  relate  here. 
One  case,  however,  is  so  remarkable,  that  an  abstract  of  it  may  be 

instructive.  M.  D ,  the  son  of  a  distinguished  physician,  between 

five  and  six  years  of  age,  was  one  day  in  summer  in  the  room  of  a 
dressmaker  who  lived  in  his  family;  this  girl,  thinking  that  she  might 
safely  put  herself  at  her  ease  before  such  a  child,  threw  herself  on  her 

bed,  almost  without  clothing.     The  little  D had  followed  all  her 

motions,  and  regarded  her  figure  with  a  greedy  eye.     He  approached 


ABUSE.  145 

her  on  the  hed,  as  if  to  sleep,  hut  he  soon  hecame  so  hold  in  his  he- 
havior,  that  after  having  laughed  at  him  for  some  time,  the  girl  was 
ohliged  to  put  him  out  of  the  room.  This  girl's  simple  imprudence 
produced  such  an  impression  on  the  child,  that  when  he  consulted 
me,  forty  years  afterwards,  he  had  not  forgotten  a  single  circumstance 
connected  with  it. 

The  continual  occupation  of  his  mind  by  lascivious  ideas  did  not 
produce  any  immediate  effect,  but  about  the  age  of  eight,  the  most 
insignificant  occurrence  served  to  turn  his  recollections  to  his  destruc- 
tion. Having  mounted  one  day  on  one  of  the  movable  frames 
which  are  used  for  brushing  coats,  he  slid  down  the  stem  which 
supports  the  transverse  bar,  and  the  friction  occasioned  caused  him 
to  experience  an  agreeable  sensation  in  his  genital  organs.  He 
hastened  to  remount,  and  to  slide  down  in  the  same  manner,  until 
the  repetition  of  these  frictions  produced  effects  which  he  had  been  far 
from  anticipating.  This  discovery,  added  to  the  ideas  constantly 
before  him,  gave  rise  to  the  most  extraordinary  abuses,  and,  after  a 
time,  to  excessive  masturbation. 

I  need  not  mention  all  the  miseries  which  followed  this  fatal  pas- 
sion ;  it  will  be  sufficient  for  me  to  relate  the  means  to  which  he  had 
recourse  for  its  correction.  He  slept  on  a  very  hard  bed  without  a 
shirt,  in  order  to  avoid  all  friction,  and  covered  by  a  single  coverlet 
sustained  by  a  cradle  ;  his  arms  were  raised,  and  crossed  over  his 
head  ;  a  servant  remained  by  his  side  during  the  night,  with  orders  to 
awake  him  if  he  changed  his  position.  When  he  got  up,  he  put  on, 
next  his  skin,  a  shirt  of  mail  weighing  twenty-two  pounds,  resembling 
those  worn  by  the  knights  of  old,  except  that  it  had  no  sleeves,  and 
that  it  was  attached,  at  its  lower  extremity,  to  a  silver  basin,  fitted  to 
receive  the  genital  organs,  and  provided  with  openings  for  the  thighs. 
This  shirt  of  mail  was  open  in  front,  in  order  to  be  easily  put  on  and 
taken  off;  and  when  on,  it  was  laced  up  with  a  steel  chain,  a  padlock 
being  attached  to  the  end,  the  key  of  which  was  kept  by  the  servant, 
who  had  orders  not  to  give  it  up  on  any  pretence  whatsoever.  Guarded 
by  the  silver  basin,  the  genital  organs  were  completely  removed  from 
the  touch,  a  little  opening  only  being  left  for  the  discharge  of  the 
urine.  As  a  still  greater  precaution,  the  patient  had  caused  four 
sharp  points  to  be  fixed  in  front  of  this  case,  in  order  directly  to  op- 
pose any  erection.  This  apparatus  he  continued  to  wear  for  nine  or 
ten  years,  although  it  frequently  caused  inflammation  of  the  testicles 
and  spermatic  cord,  by  its  pressure.  Notwithstanding  all  these  pre- 
cautions, the  patient's  moral  and  physical  condition  were  deplorable, 
which  led  me  to  suspect  the  presence  of  diurnal  pollutions. 

I  should  observe,  that  in  all  the  cases  of  which  I  have  just  spoken, 
the  children  were  five  or  six  years  of  age — at  most  eight — that  they 
did  not  show  signs  of  puberty  for  several  years  afterwards,  and  that 
they  were  not  exposed  to  the  influence  of  bad  example.  Their  sexual 
ideas  were,  therefore,  spontaneously  developed,  several  years  before 
the  development  of  the  genital  organs.     The  same  precocity  is  often 


146  CAUSES    OF    SPEEMATOKEHCEA. 

observed  in  children  of  the  other  sex.  Of  this  I  shall  treat  more  fully 
hereafter;  at  present,  I  shall  merely  call  attention  to  the  case  related 
by  Parent  du  Chatelet/  of  a  little  girl,  who,  from  the  age  of  four 
years,  gave  herself  up  to  the  most  unbridled  abuses. 

From  these  facts  an  important  scientific  conclusion  may  be  deduced, 
viz.,  that  in  many  children  the  genital  instinct  shows  itself  with 
much  energy  many  years  before  the  age  of  puberty. 

A  no  less  important  practical  precaution  presents  itself,  viz.,  that 
the  age  of  puberty  should  not  be  waited  for,  in  order  to  surround 
children  with  prudent  circumspection,  and  to  prevent  their  curiosity 
from  being  gratified. 

Many  parents  are  remarkably  careless  on  the  latter  point ;  they 
permit  children  of  both  sexes  to  play  together,  promiscuously,  for 
hours,  without  any  surveillance,  provided  that  they  are  removed  from 
all  danger  of  accident,  and  that  their  noise  is  not  annoying.  The 
confidence  of  many  parents,  also,  in  the  ignorance  of  their  children, 
makes  them  careless  of  the  marks  of  familiarity  which  are  given  to 
each  other  in  their  presence ;  children's  sleep  i^  not  always  so  real 
or  so  sound  as  it  seems. 

It  is  sufficient  to  point  out  these  facts;  every  person  can  deduce 
the  conclusions ;  and  now  I  hasten  to  consider  a  question,  the  gravity 
of  which  has  been  allowed  by  all  who  have  written  respecting  mas- 
turbation— I  mean  the  influence  of  example  in  educational  establish- 
ments. 

If  I  may  judge  from  my  own  observations,  out  of  ten  persons  whose 
health  has  been  deranged  immediately  or  remotely  from  the  effects  of 
masturbation,  nine  first  contracted  the  habit  at  school.  All  that  I 
have  read  on  the  subject  has  led  me  to  conclude  that  this  proportion 
is  not  exaggerated.  A  child  brought  up  in  the  bosom  of  his  family 
is,  it  is  true,  surrounded  by  many  causes  sufficient  to  arouse  his  curi- 
osity and  excite  his  imagination  ;  but  such  causes  act  accidentally, 
and  in  an  isolated  manner ;  they  only  produce  a  serious  effect  on  a 
few  ardent  imaginations ;  a  thousand  circumstances  may  remove  the 
attention  from  them.  At  school  it  is  admitted  that  such  causes 
do  not  exist,  but  there  are  others,  less  numerous  and  less  varied,  but 
which  operate  in  a  much  more  active  and  continuous  manner  ;  the 
effects  of  these  are  direct,  and  almost  inevitable.  The  child  finds, 
on  his  first  arrival,  a  focus  of  contagion,  which  soon  spreads  itself 
around  him  ;  the  vice  is  established  endemically,  and  is  transmitted 
from  the  old  pupils  to  those  newly  arriving.  If  a  few  privileged  indi- 
viduals escape  being  initiated,  they  are  only  such  as  do  not  experi- 
ence any  gratification.  But  their  time  will  come  at  a  later  period  ; 
when  the  passions  make  themselves  felt,  the  same  circumstances  will 
be  presented  to  the  mind,  under  a  less  disgusting  aspect.    I  shall  not 


1  Annales  d'Hygifene  Publique  et  de  Medecine  Legale,  torn.  vii.     Ire  Partie,  1832, 
page  173. 


I 


ABUSE.  147 

enter  into  details  on  this  subject ;  but  from  all  that  has  come  to  my 
knowledge,  from  various  and  direct  sources  of  information,  I  do  not 
hesitate  to  affirm,  that  nowhere  are  obscene  books  circulated  more 
freely  and  boldly,  than  in  educational  establishments;  that  the  origin 
of  the  vice  is  not  solely  in  the  scholars,  but  also  in  the  ushers  and 
servants  ;  that  the  abuses  are  not  always  confined  to  masturbation: 
and  that  they  are  not  always  propagated  by  example  or  persuasion, 
but  are  sometimes  enforced  by  threats  and  violence.  Let  it  not  be 
thought  that  I  am  now  speaking  of  rare  and  exceptional  cases,  or 
that  I  exaggerate  ;^  I  possess  multiplied  and  convincing  proofs  of 
my  assertions.  I  would  not,  either,  that  I  should  be  misunderstood. 
I  am  far  from  denying  the  advantages  of  education  in  a  public 
school  ;  and  I  am  ready  to  admit  that  the  competition  among  a  num- 
ber of  children  produces  emulation,  forms  the  future  character,  early 
shows  each  his  own  value,  and  lays  the  foundation  of  friendships 
which  endure  through  life.^ 

A  too  sedentary  life  is  injurious  at  all  ages,  especially  in  child- 
hood, when  there  exists  such  constant  desire  for  exercise  and  change. 
Gymnastics,  therefore,  should  on  this  account  alone  occupy  an  im- 
portant position  in  the  system  of  education;  but  they  must  be  viewed 
under  a  much  more  serious  aspect.  Nothing  can  prevent  the  genital 
organs,  at  the  time  of  their  development,  from  reacting  on  the  eco- 
nomy and  giving  rise  to  new  sensations  and  ideas.  It  is  impossible 
to  prevent  the  attention  from  being  attracted  by  the  impressions 
caused  by  these  organs  ;  impossible  to  restrain  the  imagination  and 
to  prevent  it  from  frequently  dwelling  on  such  impressions.  The 
slightest  circumstances  may,  in  such  a  case,  lead  to  a  fatal  discovery, 
even  if  the  information  be  not  transmitted  directly,  and  enforced  by 
example.  How  are  such  discoveries  to  be  prevented ;  or  rathei-,  how 
are  their  results  to  be  guarded  against?  Study  gives  us  no  aid  here; 
indeed  the  continually  sitting  necessarily  heats  the  organs  already  too 
excited.  The  eyes  may  be  fixed  on  the  book,  the  ears  may  appear  to 
listen  to  the  master,  but  who  can  guard  against  the  wandering  of  the 
imagination  ?  At  night  it  is  still  worse ;  no  surveillance  can  prevent 
this.     There  exists  only  one  means  capable  of  counteracting  it,  and 


•  M.  Lallemand,  of  course,  speaks  of  the  colleges  and  private  schools  in  France.  I 
regret  to  say  that  his  statements  apply  with  nearly  the  whole  of  their  force  to  the 
schools  of  England.  Vice  is  common  in  them,  neglect  of  physical  education  and  the 
contracted  nature  of  the  studies  to  which  pupils  are  confined  in  our  classical  semina- 
ries— the  understanding  being  unappealed  to,  and  the  reasoning  faculties  unexercised 
— the  natural  sciences  neglected,  and  the  whole  of  the  pupil's  life  until  the  age  of 
seventeen  employed  in  the  study  of  the  dead  languages — are  matters  of  vital  import- 
ance to  which  society  has  only  recently  begun  to  direct  its  attention.     [H.  J.  McD.] 

*  M.  Lallemand  enters  very  fully  on  the  subject  of  education  as  conducted  in  France, 
and  well  exposes  the  errors  of  the  system.  Most  of  his  remarks  apply  to  our  own 
educational  system,  yet,  as  the  subject  is  not  strictly  medical ;  and  as,  moreover,  M. 
Lallemand  has  treated  it  at  considerable  length,  I  think  it  best  to  refer  those  of  my 
readers  who  may  wish  information  on  it  to  the  original  work.  Vol.  I.  page  425. 
[H.  J.  McD.] 


148  CAUSES    OF    SPERMATOEEHCEA. 

that  is,  muscular  exercise  carried  so  far  as  to  induce  fatigue.  This 
alone  is  able  to  deaden  the  susceptibility  of  the  newly  acting  organs 
which  excite  the  economy ;' exercise  alone,  by  requiring  matter  for 
the  repair  of  the  muscular  waste  it  causes,  withdraws  a  stimulus  from 
the  genital  organs,  and  induces  sound  and  refreshing  sleep. 

Varieties  of  Apuse, — I  think  it  will  be  useful  for  me  to  give  a 
few  details,  respecting  the  different  kinds  of  abuse  which  have  come 
under  my  notice,  and  of  which  I  have  seen  the  hurtful  influence  on 
the  genital  organs.  I  shall  omit  all  such  remarks  as  have  not  a 
strictly  practical  bearing. 

We  have  already  seen  the  dangers  to  which  compression  of  the 
urethra,  to  prevent  the  discharge  of  semen  during  ejaculation,  may 
give  rise  (case  thirty-five).  In  the  case  I  have  related,  it  seems  likely 
that  a  rupture  took  place  in  the  mucous  membrane,  because  the 
patient  felt,  at  the  instant,  an  acute  pain,  and  the  following  day  a 
discharge  commenced,  which  continued  until  the  application  of  the 
nitrate  of  silver.  Soon  after  the  commencement  of  the  discharge, 
involuntary  seminal  emissions  occurred,  attended  with  serious 
symptoms.  It  was  immediately  behind  the  glans  that  this  patient 
compressed  the  urethra,  and  it  is  quite  conceivable  that  the  sudden 
and  violent  distension  of  the  canal  might  cause  a  tear  in  the  mu- 
cous membrane.  But  this  is  not  always  the  case  ;  one  of  my  patients 
writes  as  follows  :  "At  the  age  of  fourteen  I  practised  masturbation 
three  or  four  times  a  week,  and  sometimes  frequently  during  the  day. 
In  order  to  prevent  the  discharge  of  semen,  I  compressed  the  root 
of  the  penis  firmly.  Nothing  escaped  at  the  time,  but  I  soon  ob- 
served that  the  semen  was  discharged  with  my  urine,  the  first  time  I 
passed  it.     I  followed  this  practice  for  about  two  years." 

Diurnal  pollutions  soon  appeared,  and  grew  more  and  more  seri- 
ous. The  remainder  of  the  case  presents  nothing  which  is  not  met 
with  in  all  cases  of  spermatorrhoea.  What  I  wish  to  call  attention 
to  here,  is,  that  the  compression  was  made  close  to  the  orifice  of  the 
ejaculatory  ducts,  and  that  the  patient  thought  at  first  that  his  ma- 
noeuvres were  not  followed  by  any  loss  of  semen,  although  he  at 
length  discovered  the  contrary.  Fournier  and  B^gin  report  a  similar 
case.*  It  was  that  of  a  young  man  who,  at  the  moment  of  ejaculation, 
compressed  the  most  remote  p;irts  of  the  urethra,  so  that  not  a  single 
drop  of  semen  could  escape.  Yet  the  result  was  the  same  as  in  ordi- 
nary cases.  Notwithstanding  his  precautions,  his  strength  dimin- 
ished, and  his  disorder  made  just  as  rapid  progress  as  if  the  seminal 
emission  had  been  perfect. 

The  following  is  even  a  more  remarkable  case.  I  shall  allow  the 
patient  to  speak  for  himself  "I  am  thirty-two  years  of  age,  and  I 
have  had  nocturnal  pollutions  from  the  age  of  fourteen  ;  I  have  also 
suffered  from  discharges  while  at  stool,  for  ten  years.  The  cause  of 
these  pollutions  cannot  be  referred  to  masturbation,  for  I  have  not 

'  Dictionnaire  des  Sciences  M^dicales,  art.  Masturbation,  page  125. 


ABUSE.  149 

practised  it  twenty  times  during  my  whole  life.  The  pollutions  are 
rather  owing  to  reading  obscene  books,  for  they  commenced  soon 
after.  At  first,  ejaculation  was  preceded  by  dreams,  and  accompa- 
nied by  active  erections  and  acute  sensations,  the  semen  being  ejacu- 
lated with  force.  I  tried  various  means  to  prevent  these  discharges. 
I  have  slept,  during  whole  nights,  with  my  penis  dipped  in  cold 
water,  or  compressed  between  two  pieces  of  wood  formed  on  purpose. 
I  have  tried  to  keep  myself  awake  in  order  to  prevent  an  emission, 
because,  when  I  succeeded,  the  following  day  I  felt  stronger,  but 
after  two  or  three  nights,  sleep  always  overpowered  me ;  I  often 
awoke,  however,  in  sufficient  time  to  prevent  the  catastrophe  of  my 
dreams,  but  frequently  it  was  too  late  ;  on  such  occasions,  to  delay 
the  discharge  or  render  it  less  copious,  I  compressed  the  base  of 
the  penis  firmly;  but  it  seems  that  these  compressions  greatly  injured 
the  parts,  without  preventing  or  diminishing  the  discharge,  which 
took  place  inwardly,  as  I  have  often  been  convinced  by  inspecting 
ray  urine.  From  that  period  the  pollutions  have  no  longer  been  pre- 
ceded by  dreams  ;  and  the  sensations  have  left  me,  so  that  I  am  not 
now  aroused  from  sleep.  My  erections  diminished,  and  have  even, 
latterly,  ceased  entirely.  For  three  years  erections  have  rarely  ac- 
companied the  emissions  ;  when  they  do  occur  I  am  always  less 
fatigued. 

"  There  is  one  thing  which  I  have  not  been  able  to  understand, 
and  which  will,  without  doubt,  appear  absurd  to  you  ;  it  is,  that  I 
experience  pollutions  without  erection,  sensation,  or  the  escape  of 
semen  by  the  urethra.  I  believe  that  the  discharge  passes  in  a  retro- 
grade direction,  and  becomes  mixed  with  urine,  because,  the  next 
morning,  I  find  little  globules,  a  cloud  and  filaments,  in  that. fluid, 
just  as  when  I  formerly  prevented  ejaculation  by  compressing  the 
root  of  the  penis;  whilst  my  urine  contains  nothing  during  the  day, 
or  the  next  morning  when  I  have  not  experienced  these  pollutions. 
On  waking,  I  am  perfectly  aware  of  what  has  occurred,  by  the  sweat 
that  covers  my  face,  the  fatigue  I  feel  in  all  my  limbs,  the  headache 
and  dazzling  that  affect  me,  the  dark  circles  that  surround  my  eyes, 
&c.  I  have  tried  cold  and  iced  applications,  with  slight  benefit. 
For  some  time  the  pollutions  were  rarer,  and  were  accompanied  with 
erection  and  sensation;  but  soon  they  became  as  before,  and  emission 
did  not  take  place  outwardly.  These  internal  pollutions  have  always 
been  the  most  weakening.  Whenever  I  succeed  in  passing  the  night 
without  sleep,  my  urine  is  transparent  in  the  morning,  and  I  feel 
strong.  After  several  nights  without  sleep,  I  generally  have  an  ener- 
getic emission,  which  fatigues  me  little;  but  soon  those  witliout  erec- 
tion and  without  external  discharge  return,  and  then  I  always  feel 
worn  out  on  waking." 

This  patient's  medical  attendant  would  not  believe  in  the  possi- 
bility of  pollution  without  external  discharge  ;  but  it  seems  clear  that 
the  patient  really  had  internal  emission,  without   perceptible    dis- 
charge ;  that  is  to  say,  that  the  semen  passed  into  the  bladder,  and  was 
10 


150  CAUSES    OF    SPEEMATORRHCEA. 

discharged  with  the  urine,  as  had  occurred  before  when  ejacuhition  was 
prevented  by  pressure  on  the  perineum.  This  compression  was  made 
in  front  of  the  ejaculatory  canals,  and  was  very  often  repeated.  It 
seems,  therefore,  likely  that  it  was  the  frequent  repetition  of  these 
manoeuvres  that,  at  length,  caused  the  spontaneous  passage  of  the 
semen  into  the  bladder.  But  this  is  a  question  to  which  I  shall  have 
occasion  to  return. 

Yet  all  these  manoeuvres  scarcely  differ  from  the  various  means 
recommended  by  some  surgeons  for  preventing  nocturnal  pollutions; 
and  we  may  thus  perceive  how  little  confidence  is  to  be  placed  in  the 
instruments  invented  for  that  purpose,  and  the  inconveniences  to 
which  they  may  give  rise.  It  seems  likely  that  the  dangers  would 
be  nearly  the  same,  in  whatever  part  of  the  penis  the  compression  is 
made  ;  except  that  if  there  be  sufficient  space  in  the  urethra,  between 
the  point  compressed  and  the  ejaculatory  ducts,  to  contain  all  the 
semen,  it  would  be  discharged  directly  the  compression  is  removed. 
When  on  the  other  hand,  the  compression  is  made  immediately  in 
front  of  the  orifice  of  the  ejaculatory  ducts,  the  semen  flows  back,  at 
least,  in  great  measure,  so  as  to  induce  the  patient  to  believe  that  the 
discharge  has  been  stopped,  or  at  all  events,  in  great  measure  di- 
minished, and  to  induce  a  degree  of  security  which  leads  to  further 
abuses. 

But  to  return  to  the  description  of  the  abuses  which  have  been 
admitted  to  me  by  so  many  other  patients. 

One  of  these  informed  me,  that  about  the  period  of  puberty,  while 
hanging  one  day  by  his  arm,  he  experienced  an  energetic  erection 
accompanied  with  pleasure,  and  that  by  his  efforts  to  raise  his  body, 
he  caused  an  abundant  seminal  emission.  This  was  the  first.  The 
next  day  he  repeated  the  same  motions,  and  noticed  the  same  phe- 
nomena, and  from  that  time  he  knew  no  other  pleasure.  From  the 
principles  which  had  been  early  instilled  into  him,  he  would  have 
thought  himself  degraded  by  connection  with  a  female,  or  by  the  least 
mutual  contact  with  his  genital  organs ;  but  his  conscience  was  quiet 
with  regard  to  these  practices,  because  they  had  not  been  forbidden 
him.  He  continued,  therefore,  to  hang  by  the  hands,  from  the  fur- 
niture, doors,  &c.,  without  being  suspected  by  any  one,  and  fell,  by 
degrees,  into  a  state  of  debility  and  wasting  equal  to  those  caused 
by  the  most  unbridled  masturbation.  After  a  time,  from  weakness, 
the  patient  lost  the  power  of  hanging,  and  his  voluntary  emissions 
ceased ;  but  they  were  soon  replaced  by  nocturnal  emissions,  which 
were  very  difficult  of  cure. 

The  following  are  a  few  passages  from  a  letter  I  have  recently 
received.  "Being  of  an  ardent  temperament,  I  abused  myself,  from 
the  age  of  eight  years,  by  practising  masturbation,  or  rather,  by  still 
more  hurtful  manoeuvres.  By  compressing  the  penis  between  my 
legs,  or  against  the  seat  on  which  I  was  sitting,  I  produced  excite- 
ment, which  was  commonly  followed  by  the  discharge  of  a  few  drops 
of  a  viscid  and  transparent  fluid.     This  practice  I  repeated  several 


I 


ABUSE.  151 

times  a  day,  up  to  the  age  of  sixteen,  when  I  ceased  entirely,  having 
been  frightened  by  the  discharge  of  nearly  pure  blood,  which  occurred 
several  times.  From  this  time  I  only  sought  natural  enjoym.ents,  but 
I  found  it  impossible  to  obtain  a  complete  erection.  This  state  was 
attributed  to  weakness,  and  was  combated  by  tonics,  stimulants,  and 
even  irritants  of  all  kinds,  which  have  done  me  much  injury.  I  used, 
also,  cold  bathing  and  cold  lotions.'' 

1  have  seen  an  officer  of  high  rank  who  had  fallen  into  the  same 
condition,  from  the  practice  of  similar  manoeuvres.  He  experienced 
his  first  sensation  against  the  leg  of  a  table,  at  the  early  age  of  ten 
years,  and  continued  for  several  years  to  employ  the  same  means.  I 
have  already  related  the  case  of  another  child,  who  allowed  himself 
to  slide  down  a  wooden  pole,  and  the  deplorable  influence  which  this 
circumstance  exercised  on  the  remainder  of  his  life. 

In  a  few  of  my  patients,  horse  exercise  caused  the  first  seminal 
emissions.  I  shall  relate,  by  and  by,  the  case  of  one  of  these  who 
knew  scarcely  any  other  pleasure,  and  who  became  quite  impotent  at 
the  age  when  virility  is  generally  greatest.  The  extreme  suscepti- 
bility which  the  genital  organs  manifest  at  the  period  of  puberty, 
should  prevent  horse  exercise  from  being  commenced  about  this 
period,  as  is  usually  done.  It  should  be  begun  a  few  years  earlier, 
or  a  few  years  later. 

I  have  already  spoken  of  the  danger  of  allowing  children  to  sleep 
on  the  abdomen  (see  case  thirty-three);  I  should  add,  that  many  of 
my  patients  thus  contracted  habits  which  ruined  their  health.  Inde- 
pendently of  the  inconveniences  to  respiration,  digestion,  &c.,  which 
arise  in  this  position,  erections  are  favored.  The  least  friction 
awakens  new  sensations,  and  once  on  the  track,  progress  is  soon 
made.  Sometimes  recollections  have  caused  the  choice  of  this, posi- 
tion ;  of  this  I  have  related  a  remarkable  example  (see  case  thirty- 
four)  ;  at  other  times,  scruples  early  instilled  by  a  sage  foresight,  but 
which  the  violence  of  the  impulse  has  at  length  succeeded  in  eluding, 
have  induced  it.  Thus,  I  have  been  told  respecting  one  of  my 
patients,  that  he  would  suffer  death  rather  than  defile  himself  by 
touching  the  genital  organs,  yet,  for  five  or  six  years,  he  seldom 
passed  a  night  without  working  his  own  destruction  while  lying  on 
his  abdomen.  It  is  not  necessary  for  me  to  enter  into  a  description 
of  the  other  means  by  which  patients  have  sought  to  satisfy  their 
genital  impulses,  without  transgressing  the  religious  and  moral  prin- 
ciples which  had  been  taught  them  from  infancy.  Suffice  it  to  say, 
that  if  they  have  succeeded  in  satisfying  their  consciences,  they  have 
not  succeeded  in  preserving  their  health. 

But  to  abstain  from  all  direct  action  on  the  genital  organs,  is  not 
always  sufficient  to  preserve  the  patient  from  serious  disorders.  A 
purely  nervous  exitement,  awakened  by  the  other  senses,  or  directly 
produced  by  erotic  ideas,  may  bring  the  same  results  as  the  worst 
abuses  if  prolonged  or  repeated  erections  are  caused  by  it.  The 
following  are  a  few  such  examples:  — 


152  CAUSES    OF   SPERMATOERH(EA. 

A  student,  aged  twenty-two,  born  in  Switzerland,  of  sanguine 
temperament,  and  great  muscular  power,  fell  into  the  most  complete 
state  of  impotence,  after  having  been  for  some  time  exposed  to  un- 
gratified  excitement.  He  had  never  practised  any  solitary  vice;  but 
violent  and  prolonged  erections  came  on,  and  were  produced  during 
the  day  by  the  influence  of  the  memory.  These  erections  caused 
abundant  and  frequent  nocturnal  pollutions.  Absence  put  an  end  to 
the  excitement.  The  nocturnal  pollutions  diminished  by  degrees,  and 
at  length  ceased  entirely.  Yet  this  patient  fell  into  the  same  state  of 
impotence  as  if  he  had  committed  the  greatest  excesses  in  masturba- 
tion, and  at  the  same  time  preserved  the  appearances  of  health  and 
strength.  The  cause  of  his  impotence  was  evident  on  examining  his 
urine,  and  causing  him  to  watch  for  diurnal  pollutions  while  at  stool, 
but  the  cure  of  these  pollutions  was  only  perfect  after  two  years' 
treatment. 

I  have  seen  another  case  of  the  same  kind,  in  a  young  man  who 
passed  from  a  state  of  habitual  priapism  to  one  of  absolute  impotence, 
without  any  other  cause  than  violent  excitement  of  the  genital  organs 
by  an  ardent  attachment ;  he  had  never  given  way  to  excess  of  any 
kind.  I  shall  record  by  and  by  another  case  of  the  same  kind.  I 
also  had  under  my  care  an  English  officer,  who  left  Calcutta  in  per- 
fect health  and  arrived  in  London  completely  impotent,  after  having 
suffered  during  two  months  from  almost  constant  erections,  excited 
by  the  presence  of  a  female  on  board  ship.  This  state,  so  opposed  to 
that  which  had  preceded  it,  continued  for  two  years — the  whole  of 
this  time  not  being  marked  by  the  least  sign  of  virility.  It  is  scarcely 
necessary  to  add,  that  this  state  was  produced  by  diurnal  pollutions. 

I  related  a  case,  a  few  pages  back  (page  136),  in  which  nocturnal 
pollutions  were  caused  by  reading  an  obscene  book :  I  have  seen  a 
multitude  of  cases  of  this  nature.  From  these  I  conclude,  that  in 
certain  very  excitable  individuals,  reading  such  works,  the  sight  of 
voluptuous  images,  lascivious  conversation,  in  a  word,  all  things  that 
can  excite  or  keep  up  irritation  in  the  spermatic  organs  are  capable 
of  producing  the  same  effects  as  actual  abuse,  even  when  the  will  is 
sufficiently  powerful  to  prevent  the  thoughts  from  leading  to  the  acts. 
On  the  other  hand,  an  abundant  secretion  of  semen  with  importunate 
erections,  irritation  of  the  urethra  and  prostate,  always  results  under 
such  circumstances ;  and  these  favor  the  occurrence  of  nocturnal  and 
diurnal  pollutions  as  serious,  and  perhaps  more  difficult  of  cure  than 
those  produced  by  masturbation,  because  it  is  impossible  to  act  di- 
rectly on  the  memory  or  the  imagination. 

It  is  not  sufficient  then  to  prevent  all  material  action  on  the  genital 
organs ;  it  is  necessary  also  to  prevent  all  erotic  excitement  of  the 
senses  and  all  concentration  of  the  ideas  on  lascivious  objects.  For- 
tune's favors  are  so  distributed  that  numbers  live  in  absolute  indo- 
lence without  being  blamed  by  the  world,  because  they  demand 
nothing  of  any  one.  This  inaction  produces  results,  the  only  remedy 
for  which  that  I  am  aware  of,  is  daily  fatigue  of  the  body  by  various 
kinds  of  exercise. 


I 


ABUSE.  153 

Effects  of  Abuses. — The  effects  produced  by  the  different  kinds 
of  abuse  of  which  I  have  been  treating,  vary  according  to  the  age  of 
the  patient,  his  idiosyncrasy  and  the  different  organs  chiefly  affected. 
I  have  laid  particular  stress  on  the  causes  which  may  lead  to  bad 
habits  some  time  before  puberty  ;  I  must  now  consider  their  effects 
during  this  period. 

The  symptoms  arising  from  masturbation  in  the  child  have  been 
always  hitherto  confounded  with  those  produced  in  the  adult  ;  they 
present  certain  distinctive  characters,  however,  which  require  our 
consideration.  However  young  they  may  be,  children  lose  tlesh,  and 
become  pale,  irritable,  morose,  and  passionate;  their  sleep  is  short, 
disturbed,  and  broken.  They  fall  into  a  state  of  marasra,  and  at 
length  die,  if  not  prevented  from  pursuing  their  courses.  Examples 
of  such  a  termination  are  so  well  known  that  I  forbear  to  quote  them. 

Analogous  symptoms  are  shown  in  the  adult — follow  nearly  the 
same  course — and  may  lead  to  the  same  termination ;  but  in  infancy 
more  or  less  severe  nervous  symptoms  are  superadded,  which  are  not 
found  in  those  who  have  commenced  the  practice  after  puberty,  or 
which  at  least  are  not  in  the  latter  case  manifested  to  the  same  extent. 
Such  are  spasms  and  partial  or  general  convulsions,  eclampsia, 
epilepsy,  and  paralysis,  accompanied  with  contraction  of  the  limbs  : 
these  phenomena  were  present  in  all  the  children  whose  cases  I  have 
noticed,  and  numerous  similar  facts  have  been  published  by  different 
authors. 

Contractions  of  the  limbs  have  been  well  investigated  by  Dr.  Guer- 
sent,^  and  he  notices  that  they  especially  affect  such  children  as  are 
lank,  unhealthy-looking,  nervous,  and  worn  out  by  bad  habits. 

The  following  case  is  sufBciently  remarkable.  In  1824  a  woman 
brought  her  son,  aged  eight,  to  the  hospital  St.  Eloi  ;  he  had  lost 
the  use  of  his  lower  extremities  for  some  months.  The  limbs  were 
fixed,  and  drawn  together,  and  all  the  muscles  contracted.  The  child 
was  extremely  thin,  and  his  intellect  was  much-disturbed.  Mastur- 
bation, the  cause  of  all  these  disorders,  had  only  been  discovered  by 
his  mother  a  few  weeks  before  she  placed  him  under  my  care,  but  she 
had  used  every  means  she  could  devise  to  prevent  it,  without  effect. 
After  two  or  three  trials  I  found  it  was  of  no  use  trusting  to  the 
strait-waistcoats  and  other  means  usually  employed,  and  accordingly 
I  determined  to  pass  a  gum-elastic  catheter  into  the  bladder,  and  to 
fix  it  so  that  the  patient  should  be  unable  to  withdraw  it.  The  pre- 
sence of  the  foreign  body  excited  inflammation  of  the  urethra,  as  I 
expected  :  when  this  occurred,  I  withdrew  the  instrument,  but  re- 
placed it  as  soon  as  the  inflammation  had  subsided.  I  kept  up,  in 
this  manner,  a  constant  state  of  inflammation  for  a  fortnight,  which 
rendered  the  parts  so  painful  that  the  child  was  unable  to  touch  them. 
This  treatment  produced  more  decisive  success  than  I  had  ventured 

1  Gazette  Medicale  de  Paris,  Fevrier,  1842. 


154  CAUSES    OF    SPEEMATORRHCEA. 

to  hope;  within  eight  days  the  lower  extremities  had  regained  suffi- 
cient streno-th  and  mobility  to  allow  the  child  to  get  up,  and  in  ano- 
ther fortnight  he  was  able  to  run  about  the  wards.  I  then  sent  him 
away,  threatening  him  with  a  return  of  the  same  treatment  if  he  re- 
lapsed. The  pain  caused  by  the  catheter  seemed  to  have  removed 
all  the  other  impressions,  for  his  health  continued  good,  and  growth 
followed  its  ordinary  course, 

I  have  since  employed  the  same  means  in  many  cases,  with  just 
as  much  success,  and  I  think  it  more  sure  than  any  other,  because  it 
is  impossible  to  rely  on  the  patient's  will,  or  on  the  assiduity  of  those 
who  are  appointed  to  watch  over  him.  In  children  too,  it  leaves  an 
impression  on  the  memory,  which  is  often  sufficient  to  destroy  the 
empire  of  habit,  and  to  prevent  a  return  to  the  former  manoeuvres. 

But  to  resume  the  consideration  of  the  symptoms  observed  in  chil- 
dren. In  childhood,  seminal  emissions  are  never  experienced,  but 
nevertheless  the  patients  fall  into  a  state  of  marasm,  to  which  some 
even  succumb.  These  effects,  like  those  observed  under  the  same 
circumstances  in  the  female,  have  induced  some  authors  to  leave  out 
of  their  consideration  the  seminal  discharges  which  are  produced  by 
the  same  acts  at  a  later  period.  They  have  attributed  the  debility 
which  follows  all  abundant  discharges  of  semen  to  the  nervous  ex- 
citement and  convulsive  motions,  which  usually  accompany  the  dis- 
charge. The  accidents  observed  before  puberty  are  evidently  only 
due  to  the  effects  on  the  nervous  system  ;  and,  the  same  sensation 
accompanying  voluntary  emissions  after  puberty,  it  is  natural  to  sup- 
nose  that  the  nervous  system  plays  as  active  a  part  then,  as  in  child- 
hood. I  willingly  admit  the  importance  of  this  nervous  exhaustion, 
in  whatever  manner  it  may  be  supposed  to  operate  ;  and  supposing, 
even,  that  its  action  on  the  economy  is  just  as  important  as  during 
childhood  (which  is  not  the  case,  as  I  shall  presently  show),  this  is 
no  reason  why  the  actual  discharges  should  not  be  taken  into  account, 
seeing  that  they  greatly  modify  the  character  and  consequences  of 
the  nervous  disturbance. 

I  have  already  noticed  that  the  symptoms  produced  by  abuses 
during  childhood  present  a  spasmodic  character :  this  character,  with- 
out doubt,  is  derived  from  the  predominance  of  the  nervous  system 
at  that  period,  rendering  children  so  alive  to  external  impressions. 
This  excessive  sensibility  also  explains  the  great  disorder  of  the  eco- 
nomy which  children  suffer  from  such  manoeuvres.  Deslandes^  re- 
lates a  case,  showing  that  any  action  of  the  same  kind  may  produce 
the  same  effects  at  this  early  age.  He  says:  "  An  observer  worthy  of 
credit.  Dr.  Nurambeau,  has  communicated  to  me  the  case  of  a  child 
who  procured  himself  similar  sensations  by  drawing  out  the  navel. 
His  health  became  much  disordered  from  the  effects  of  this  strange 
habit,  which  had  such  a  power  over  him,  that  coercive  measures  were 

'  De  rOnanisme  et  des  autres  abus  v^neriens,  page  462. 


ABUSE.  155 

required  for  its  correction.  It  is  worthy  of  remark  that  this  patient 
showed  neither  erection,  nor  any  other  phenomenon  of  the  generative 
organs,  which  at  all  referred  to  sexual  intercourse."  The  organs  of 
generation,  therefore,  had  no  influence  in  producing  the  sensations 
experienced  by  this  child  ;  but  the  repeated  titillation  of  a  very  sensi- 
tive part  produced  the  same  disorder  as  masturbation. 

It  was  proved  jn  the  debates  on  a  recent  criminal  trial  that  death 
may  be  caused  by  prolonged  tickling  the  sole  of  the  foot.  Nervous 
disorder,  arising  from  such  proceedings,  may  then  be  carried  so  far 
as  to  cause  death,  and  from  this  may  be  imagined  the  effects  of  the 
multiplied  convulsive  shocks  which  irritable  children  produce/  by 
acting  on  the  most  sensitive  organs  in  the  economy. 

Every  excessive  loss  of  semen  also,  even  when  unaccompanied  by 
sensation,  is  followed  by  debility,  and  this  may  be  carried  so  far  as  to 
cause  death ;  I  have  related  several  such  cases  in  the  beginning  of 
this  work. 

There  exist,  then,  two  distinct  causes  ;  nervous  disturbance  and 
debilitating  discharges,  and  both  these  act  at  once,  when  seminal 
emissions  are  produced  by  the  influence  of  the  will.  It  is  not  to  be 
wondered  at,  that  both  these  causes  should  produce  nearly  the  same 
symptoms,  because  they  both  weaken  the  economy.  The  action  of 
the  first  on  the  nervous  system  is  direct  and  immediate,  and  the 
symptoms  that  result  from  it  are  of  a  more  spasmodic  character.  It 
is  very  easy  to  confound  these  two  causes  when  they  act  simultane- 
ously ;  but  I  have  just  shown  that  they  can  be  considered  separately. 
The  following  reason  shows  the  importance  of  so  doing. 

Whenever  we  succeed  in  entirely  putting  a  stop  to  the  habits  of 
abuse  in  children,  we  may  make  sure  of  obtaining  their  return  to 
health,  and  that  very  quickly.  This  I  have  remarked  in  all  the  cases 
of  children  that  have  come  under  ray  care.  I  do  not  mean  to  infer 
that  the  disorder  done  to  nutrition  during  the  progress  of  development 
is  easily  repaired,  but  that  the  acute  symptoms  rapidly  disappear,  and 
that  all  the  functions  are  quickly  re-established.  If  the  effects  pro- 
duced are  active  and  serious  they  cease  very  rapidly,  as  soon  as  the 
cause  is  removed,  and  return  to  health  becomes  certain.  Unfortu- 
nately, matters  do  not  follow  so  simple  a  course  after  puberty. 

What  I  have  just  said  respecting  children,  applies  equally  to 
females  :  this  is  easily  shown  by  examining  the  cases  in  which  excision 
of  the  clitoris  has  been  performed  for  the  cure  of  nymphomania.  The 
state  of  these  unfortunates  must  have  been  deplorable  indeed,  to  justify 
the  resort  to  such  means ;  yet  they  recovered  very  rapidly. 

Why  in  these  two  classes  of  cases,  is  the  cure  certain  and  the 
return  to  health  rapid,  as  soon  as  the  vice  has  been  mastered  ?  It  is 
that  the  cause  of  the  weakness  immediately  ceases  to  act  on  the 
economy.  Why  is  it  that  so  many  men  continue  to  waste  away  after 
they  have  entirely  left  off  their  habits  of  abuse  ?  It  is  because  diurnal 
pollutions  have  commenced,  which  are  even  more  debilitating  than 
the  abuses  which  gave  rise  to  them. 


156  CAUSES    OF    SPERMATOERHCEA. 

Dr.  Deslandes  and  many  others  have  discovered  that  there  is  a 
great  difference  in  the  conditions  of  persons  who  have  practised 
masturbation  for  some  time,  and  then  renounced  it ;  but  they  have 
not  sought  the  explanation  of  this  fact.  It  is,  however,  very  im- 
portant to  know  why  some  are  cured  rapidly  and  completely,  while 
others  continued  to  suifer  and  languish  during  the  remainder  of  their 
lives.  The  symptoms^experienced  by  the  latter  ^-e  those  produced 
by  diurnal  pollutions. 

But  if  we  inquire  why  some  should  be  affected  by  diurnal  pollutions 
while  others  are  exempt,  we  discover  that  we  have  been  comparing 
two  very  different  classes  of  patients.  The  one  class  conquered  their 
bad  habits  by  the  force  of  their  will ;  the  other  class  were  compelled 
to  renounce  them  by  impotence.  The  former  resisted  their  desises 
while  they  were  yet  active  ;  they  required  much  perseverance  and 
moral  energy  in  order  to  succeed;  the  latter  only  left  off  as  they  were 
less  tempted — the  progressive  decrease  in  their  erections  being  due 
to  the  presence  of  undiscovered  diurnal  pollutions. 

Such  patients  deceive  themselves  as  to  the  cause  of  their  changing 
their  habits,  and  are  astonished  at  not  iSnding  any  benefit  arise  from 
such  change.  Some  of  them  even  remark  to  their  medical  attendants 
that  it  is  after  they  have  left  off  their  mal-practices  that  their  health 
has  become  altered. 

All  these  circumstances,  embarrassing  at  first  sight,  are  easily  ex- 
plained on  a  little  reflection.  At  first  the  genital  organs  are  healthy  ; 
the  constitution  is  uninjured  ;  no  seminal  emissions  occur  except 
those  that  are  induced  voluntarily  ;  and  the  activity  of  the  digestive 
organs  permits  a  rapid  repair  of  the  losses.  But  as  soon  as  irritation 
is  set  up  in  the  spermatic  organs,  a  large  quantity  of  semen  is  secreted 
and  escapes  every  day,  and  several  times  a  day,  without  the  patient's 
knowledge;  the  digestion  is  disordered;  the  erections  and  voluptuous 
sensations  diminish,  because  the  semen  is  less  perfectly  formed  ;  the 
provocatives  are  therefore  weakened  by  degrees,  and  the  patient 
renounces,  without  difficulty,  habits  which  only  inspire  him  with  dis- 
gust. He  wonders  that  his  health  still  continues  to  grow  worse,  for 
he  has  not  discovered  that  he  passes  daily,  by  often  repeated  evacua- 
tions, more  semen  than  he  formerly  passed  in  a  perceptible  manner, 
and  he  does  not  take  into  account  the  difficulty  felt  by  his  economy 
of  repair'ing  these  frequent  discharges. 

We  must  not,  then,  confound  those,  whose  virility  leaves  them,  with 
those  whom  the  power  of  their  will  causes  to  recover,  and  we  must 
not  be  surprised  at  seeing  the  alteraiion  in  the  habits  of  each  followed 
by  very  different  consequences. 

In  order  to  make  the  distinctive  characters  of  these  two  positions 
clear,  I  have  laid  stress  on  their  most  striking  points,  but  there  are 
numerous  slight  shades  of  distinction,  which  I  have  not  mentioned. 
For  instance,  in  some  cases  the  two  classes  of  phenomena  occur  suc- 
cessively in  a  very  distinct  manner,  at  very  near  periods.  Many 
patients  having  corrected  themselves  once,  find  their  health  promptly 


ABUSE.  157 

re-established.  But  when,  after  recovering  their  strength,  they  have 
relapsed  into  their  former  habits,  on  renouncing  them  a  second  time 
thej  obtain  no  benefit.  These  different  results  under  apparently 
similar  circumstances  can  only  be  explained  by  the  occurrence  of 
diurnal  pollutions  in  consequence  of  the  return  to  the  habits  of  abuse. 

Case  thirty-one  is  a  clear  and  perfect  proof  of  the  correctness  of 
this  explanation  ;  the  patient  recovered  twice  after  having  twice 
conquered  his  passion,  but  the  third  time  he  only  gave  it  up  through 
disgust,  and  his  health  continued  to  deteriorate  until  cauterization 
arrested  the  diurnal  pollutions  from  which  he  suffered. 

There  are  many  circumstances  which  interfere  with  the  good  reso- 
lutions of  those  addicted  to  masturbation.  After  a  few  days  of  abso- 
lute continence,  attained  with  much  difficulty,  they  frequently  suffer 
from  nocturnal  pollutions,  the  more  frequent  and  the  more  abundant 
in  proportion  as  the  spermatic  organs  have  been  much  irritated:  the 
patients  always  feel  more  debilitated  by  these  involuntary  discharges, 
than  by  those  which  they  previously  excited.  Instead  of  combating 
these  pollutions  by  suitable  means,  or  after  having  employed  one  or 
two  plans  unsuccessfully,  they  think  they  will  be  able  to  diminish  the 
evil  by  recurring  to  their  former  habits  at  distant  intervals,  and  they 
thus  relapse,  increasing  still  more  the  irritation  of  the  parts.  Soon 
after  diurnal  pollutions  commence,  and  rapidly  produce  their  effects, 
but  as  these  are  not  discovered,  the  patients  rejoice  to  find  the  noc- 
turnal discharges  gradually  disappearing.  But  their  health  daily 
grows  worse :  this  they  cannot  comprehend,  and  are  frequently  led 
to  imagine  that  they  have  mistaken  the  cause  of  their  disorder. 

Sexual  intercourse  has  been  generally  recommended  in  such  cases, 
and  sometimes  with  advantage;  but  this  means  is  like  all  others,  the 
patient  must  be  able  to  employ  it,  and  even  then  it  is  necessary  to 
distinguish  the  circumstances  in  which  it  is  hurtful,  from  those  in 
which  it  is  advantageous.  Very  often  the  patients  find  intercourse 
impossible;  while,  on  the  other  hand,  many  of  those  who  have  been 
able  to  accomplish  the  act,  have  had  an  exacerbation  of  their  symp- 
toms as  the  result. 

Whence  arises  this  difference  of  result,  in  individuals  placed  in  ap- 
parently similar  circumstances?  Some  have  diurnal  pollutions  kept 
up  by  the  irritation  of  the  organs,  while  others  are  exempt  from  them. 

All  authors  consider  masturbation  to  be  one  of  the  most  frequent 
causes  of  hypochondriasis,  but  the  reason  why  this  affection  con- 
tinues so  long  after  the  patients  have  left  off  the  habit  has  not  been 
hitherto  explained.  If  it  only  arose,  as  has  been  supposed,  from 
weakness  of  the  system,  or  disorder  of  the  nervous  functions,  how 
is  it  that  the  various  modes  of  treatment  employed — the  travelling, 
exercise,  and  amusements  of  every  kind,  should  produce  no  effects  ? 
In  every  case  of  this  nature  that  I  have  met  with,  I  have  found  the 
hypochondriasis  kept  up  by  diurnal  pollutions,  which  were  unsus- 
pected by  most  of  the  patients ;  the  intellectual  and  moral  faculties, 
together  with  the  digestion,  sleep,  kc,  improved  in  such  patients  in 


158  CAUSES    OF    SPEEMATOEEH(EA. 

proportion  as  the  pollutions  diminished,  and  the  return  to  health  was 
complete  as  soon  as  they  had  entirely  disappeared.  The  thirty- 
second  case  is  a  remarkable  instance  of  this  kind,  and  shows  the 
strano-e  monomania  which  accompanied  hypochondriasis,  as  well  as 
the  rapidly  beneficial  effects  derived  from  cauterization  of  the  urethra. 
Many  authors  have  noticed  the  indifference  which  persons  addicted 
to  masturbation  show  towards  the  opposite  sex.  This  sentiment  is, 
indeed,  very  common  in  those  who  have  carried  their  abuses  to  a 
great  extent;  but  I  do  not  think  it  arises,  as  has  been  stated,  from 
the  long  habit  of  solitary  vice:  at  all  events,  I  can  assign  a  more 
direct  cause  for  this  indifference,  viz.,  the  relative  impotence  of  the 
patients  ;  I  say  relative  impotence,  because  they  possess  sufficient 
power  of  erection  to  permit  the  practice  of  masturbation,  but  not 
enough  to  admit  of  sexual  intercourse  ;  and  such  patients  seldom 
manifest  any  dislike  to  the  opposite  sex  until  they  have  experienced 
several  disappointments,  the  remembrance  of  which  constantly  haunts 
them.  Their  views  change  immediately  that  the  diurnal  pollutions 
which  kept  up  this  impotence  are  arrested. 

Effects  of  Temperament,  Idiosyncrasy,  cbc. — The  effects  of  abuses 
vary  much  in  their  characters  and  intensity  according  to  the  indivi- 
duals attacked.  Some  persons  are  uninjured  by  the  most  unbridled 
abuses,  even  when  long  continued,  whilst  others  are  very  quickly 
disordered  by  slight  abuse.  In  this  respect  I  have  witnessed  very 
opposite  cases  with  every  variety  of  intermediate  degree. 

Temperament  seems  to  have  little  influence  in  producing  this  ine- 
quality of  resistance.  Strength  or  feebleness  of  constitution  is  not  of 
so  much  importance  as  might  be  supposed.  The  very  unequal  power 
of  the  genital  organs  affords  the  only  satisfactory  explanation.  I 
shall  refer  to  this  point  more  fully  when  treating  of  venereal  excesses. 

Idiosyncrasy:  in  the  same  individual  all  the  organs  are  not  equally 
affected  by  abuse  ;  this  is  shown  by  the  frequent  predominance  of 
certain  symptoms  which  give  to  the  case  a  particular  appearance,  and 
are  apt  to  lead  to  grave  errors  of  diagnosis  and  treatment.  I  have 
related  many  cases  in  which  this  occurred.  The  presence  of  special 
symptoms,  whenever  a  generally  debilitating  cause  acts  on  the  eco- 
nomy, arises  from  inequality  of  development,  or  of  activity,  existing 
in  certain  organs.  I  shall,  at  present,  only  consider  the  direct  and 
immediate  action  of  abuses  on  the  genital  organs,  so  as  to  show  the 
mode  in  which  they  produce  nocturnal  and  diurnal  pollutions. 

Urethral  discharges. — Attacks  of  blennorrhagia  are  more  frequent 
in  persons  addicted  to  masturbation,  than  is  generally  supposed. 
Cases  of  this  kind  have  frequently  fallen  under  my  notice  ;  in  the 
greater  number  of  these  patients  the  discharge  was  small  in  quantity, 
viscid,  and  nearly  transparent,  or  very  slightly  colored.  It  scarcely 
differed  in  appearance  from  the  prostatic  secretion.  But  in  many 
patients  the  discharge  was  abundant,  more  or  less  colored,  and 
attended  with  pain  in  the  urethra,  especially  during  the  passage  of 
urine.       Several  suffered  from  all    the   symptoms  of    a  contagious 


ABUSE.  159 

blennorrhagia;  in  others  the  same  symptoms  recurred  two  or  three 
times,  and  in  one  patient  the  discharge  reappeared  as  many  as  five 
times,  always  from  the  same  cause.  It  is  worthy  of  notice,  that  there 
existed  a  kind  of  intermittence  in  the  habits  of  the  last  mentioned 
patients ;  after  having  been  moderate  or  even  quite  continent  for 
some  time,  they  recommenced  masturbation  with  fury,  and  the  ure- 
thral •  discharges  supervened  on  these  relapses.  Two  of  my  other 
patients  suffered  from  stricture  of  the  urethra  after  one  of  these  at- 
tacks of  blennorrhagia,  just  as  occurs  after  contagious  blennorrhagia, 
and  in  one  of  these  cases,  the  stricture  was  very  tight  and  very  dif- 
ficult of  cure. 

I  should  remark,  that  I  am  now  speaking  of  patients  who  had 
never  had  sexual  intercourse,  and  that  I  leave  out  of  the  question 
such  as  had  suffered  from  cutaneous  affections,  in  which  the  urethral 
mucous  membrane  might  have  participated.  I  must  add  that  thirteen 
of  such  patients  had  not  reached  the  age  of  puberty  when  the  dis- 
charges occurred. 

These  discharges  not  having  been  excited  by  any  virus  or  by  any 
constitutional  disposition,  must  be  referred  to  the  effects  of  mastur- 
bation. Many  of  them  having  occurred  before  the  age  of  puberty, 
it  is  evident  that  they  could  not  consist  of  semen. 

Prostatitis. — Several  of  my  patients  suffered  from  retention  of 
urine  after  the  most  frightful  abuses ;  and  it  was  necessary  to  relieve 
some  of  them  with  the  catheter.  In  one  patient  an  abscess  formed 
in  the  prostate,  and  discharged  through  the  perineum. 

Cystitis. — I  have  related  many  cases  of  acute  and  chronic  cystitis 
of  which  masturbation  was  the  sole  cause. 

Emissions  of  Blood. — Some  of  my  patients  had  carried  their  pas- 
sion so  far  as  to  provoke  emissions  of  pure  blood,  or  of  semen  mixed 
with  blood.  Authors  contain  many  such  cases,  which  show  that  the 
pathological  condition  of  the  urethra  has  extended  itself  to  the  lining 
of  the  seminal  vesicles.  Other  patients  suffered  from  more  or  less 
severe  attacks  of  hgematuria  ;  many  experienced  irritation  of  the 
bladder  and  kidneys,  attended  with  an  abundant  secretion  of  bloody 
urine  and  constant  desire  to  pass  water ;  sometimes  even  micturition 
was  involuntary.  Thus  the  inflammation  or  irritation  caused  by 
masturbation,  may,  like  that  accompanying  blennorrhagia,  extend  by 
degrees,  until  it  reaches  the  kidney.  It  will  be  easily  believed 
that  the  irritation  does  not  extend  in  this  direction  only. 

Orchitis. — I- have  seen  several  cases  in  which  the  patients  suffered 
from  acute  attacks  of  orchitis,  after  furious  masturbation  ;  and  fre- 
((uently  such  orchitis  has  required  very  active  treatment  for  its  relief. 
In  one  case  the  patient  had  not  reached  puberty  when  this  occurred. 
In  many  such  cases  no  doubt  accessory  circumstances  existed,  al- 
though the  patients  attributed  the  development  of  the  orchitis  only 
to  masturbation.  Others  more  slightly  affected  experienced  pain  in 
the  testicles  and  spermatic  cord,  accompanied  with  swelling  of  the 
epididymis.    Others,  again,  suffered  a  painful  sense  of  tension.    They 


160  CAUSES    OF    SPERMATORRHCEA. 

felt  as  if  the  testicles  were  held  in  a  vice  or  squeezed  by  a  hand  of 
iron.  In  many,  the  least  contact  of  the  parts  with  the  clothes  was 
insupportable,  and  the  weight  of  the  testicles  caused  very  severe 
dra'Tcrintr  pain.  In  all  such  cases  the  patients  were  obliged  to  wear 
suspensory  bandages,  and  often  to  guard  the  testicles  from  friction, 
with  cotton,  wool,  or  swansdown. 

These  symptoms,  which  I  have  considered  separately,  generally 
occur  together,  and  often  form  varying  groups,»which  present  special 
appearances,  depending  on  the  predominance  of  one  of  the  symptoms. 
Sometimes  the  patients  mention  one  circumstance  only,  because  that 
one  alone  has  attracted  their  attention;  but  when  questioned,  they 
recollect  many  others  which  appeared  trifling  by  the  side  of  the  more 
serious  one.  It  is  also  important  to  remark,  that  diurnal  pollutions 
generally  follow  very  soon  after  the  appearance  of  these  symptoms, 
and  that  the  patients  are  a  long  time  without  discovering  them,  and 
sometimes  only  detect  them  when  taught  what  to  expect. 

The  more  we  reflect  on  these  morbid  phenomena,  and  the  course 
of  their  appearance,  the  more  striking  is  the  resemblance  between 
the  efi"ects  of  excessive  masturbation,  and  those  of  blennorrhagia.  I 
admit  that  the  symptoms  do  not  always  present  the  characters  of 
well  marked  inflammation,  but  they  at  least  show  those  of  active 
irritation  of  the  parts.  It  is  easy  enough  to  give  a  clear  explanation 
of  what  passes  in  all  cases  of  this  kind,  with  perhaps  some  slight 
shades  of  difference.  The  testicles  secrete  more  semen,  which  is  im- 
perfectly formed ;  the  seminal  vesicles,  participating  in  the  state  of 
irritation  of  the  neighboring  organs,  do  not  easily  bear  its  presence  ; 
they  contract  more  readily,  as  they  are  more  easily  affected  by 
external  impressions.  Hence,  it  becomes  more  and  more  difficult 
to  avoid  nocturnal  pollutions;  after  a  little  time  diurnal  pollutions 
occur,  and  become  more  and  more  frequent  and  abundant ;  that  is 
to  say,  there  is  a  constant  disposition  in  the  seminal  vesicles  to  con- 
tract spasmodically  and  expel  their  contents. 

On  the  other  hand,  the  semen,  ill-secreted  by  the  testicles,  and 
remaining  a  shorter  time  in  its  reservoirs,  becomes  thinner  and  more 
watery  ;  and  by  degrees,  as  it  loses  its  physiological  characters,  it 
also  loses  its  normal  properties ;  it  becomes,  therefore,  unfit  to  pro- 
duce its  efi'ects  on  the  seminal  vesicles.  The  erections  are  conse- 
quently less  energetic  and  less  lasting,  and  after  a  time  incomplete 
and  fleeting  ;  whilst  in  the  end,  in  severe  cases,  they  disappear  al- 
together. Hence  tne  embarrassment  and  timidity  of  such  patients 
in  the  company  of  females,  and  the  fear  they  experience  of  finding 
themselves  in  a  position  to  expose  their  impotence  ;  and  hence  their 
indifference  and  even  aversion  for  the  sex,  and  the  constantly  in- 
creasing difficulty  they  experience  in  changing  their  habits.  Such 
abuses,  then,  because  their  eff'ects  remain  long  after  the  habits  have 
been  altered,  bring  on  symptoms,  of  which  the  cause  is  unsuspected. 
This  is  the  reason  why  the  health  of  some  continues  to  deteriorate, 
whilst  that  of  others  is  re-established  as  soon  as  they  have  renounced 


VENEREAL    EXCESSES.  161 

their  mal-practices :  this  is  -why  tonics,  aphrodisiacs,  cold  bathing, 
and  iced  drinks,  produce  effects  so  different  from  those  expected. 

There  are  undoubtedly  cases  in  -which  the  spermatic  organs  are 
weakened  and  relaxed  ;  I  shall  relate  several  instances  of  this  in  a 
future  chapter  ;  but  we  shall  then  see  that  such  a  state  arises  from 
primary  relaxation  of  habit  and  rather  from  want  of  use  of  the 
organs  than  from  their  abuse. 

In  concluding  my  remarks  on  the  subject  of  masturbation,  I  may 
observe,  that  it  is  the  most  dangerous  of  all  vices  of  this  nature,  be- 
cause it  is  the  most  difficult  to  discover  and  to  prevent,  and  because 
it  does  not  require  any  assistance  for  its  consummation.  From  the 
cases  I  have  seen,  I  conclude  that  the  irritation  excited  by  such 
manoeuvres  very  easily  induces  involuntary  discharges  ;  that  the  ap- 
pearance of  nocturnal  pollutions  in  those  who  attempt  to  abandon 
the  vice  often  causes  them  to  return  to  their  former  habits,  and  that  the 
diminution  of  virility  which  follows,  far  from  favoring  the  patient's 
amendment,  frequently  hinders  it  by  proving  an  obstacle  to  their 
having  sexual  intercourse,  while  it  does  not  prevent  them  from  con- 
tinuing their  bad  practices.  This  circumstance  is  a  powerful  cause 
of  the  disorders  which  attend  such  as  are  reduced  by  vicious  habits. 


CHAPTER  VII. 

CAUSES  OF  SPERMATORRHEA. 

Venereal  Excesses. 

I  consider  venereal  excesses  to  consist  of  all  sexual  intercourse 
carried  beyond  the  actual  wants  of  the  system. 

CASE  XXXVI. 

Nervous  temperament— ^Excessive  intercourse  at  the  age  of  twenty-one,  con- 
tinued during  eighteen  montha — Increasing  derangement  of  health — Si/mp- 
toms  of  gastritis,  and.  of  disease  of  the  heart — Repeated  abstraction  of 
hlood — Nocturnal  and  ajterwards  diurnal  pollutions ;  Milk  diet,  &c. — 
Acupuncture  followed  hy  perfect  recovery. 

Whilst  in  Paris,  in  1822,  I  was  called  in  consultation  with  MM.  Dupuy- 
tren,  Broussais,  and  Kecamier,  to  consider  the  case  of  a  young  man  who 
was  supposed  to  be  affected  with  cardiac  disease,  accompanied  with  chronic 
gastro-enteritis.  We  could  not  quite  agree  on  the  importance  of  the  two 
orders  of  symptoms,  but  the  indications  appearing  the  same  in  each,  a 
course  of  treatment  and  regimen  was  determined  on,  which  I  undertook  to  put 
into  execution.     Before  proceeding,  however,  to  repeat  the  abstraction  of 


162  CAUSES    OF    SPERMATOREHCEA. 

blood,  which  had  already  been  practised  several  times,  and  from  which  the 
patient  had  never  experienced  relief,  I  questioned  him  further.  My  opinion 
respecting  his  disorder  changed  from  the  information  I  then  received.  The 
following  are  the  facts  : — 

]y[_  E.  g_ .  wa.s  short,  thin,  and  very  dark ;  of  a  nervous  temperament, 

and  an  ardent  and  bold  character.  His  parents  were  healthy  :  he  had  been 
early  inured  to  exposure  to  the  weather,  and  to  the  rudest  exercise ;  and 
by  an  active  life  had  avoided  all  bad  habits,  as  well  as  all  commerce  with 
women. 

At  the  age  of  twenty-one  he  married,  and  during  eighteen  months,  carried 
sexual  intercourse  to  excess.  At  first,  all  his  functions  became  more  active ; 
he  felt  gayer,  and  more  energetic  ;  and  his  appetite  was  much  increased. 
But  after  a  time,  this  excitement  began  to  diminish,  and  by  degrees  gave 
place  to  the  opposite  state.  .His  sleep  was  broken  and  unrefreshing;  he  felt 
heavy  during  the  day,  and  his  thoughts  constantly  wandered ;  his  digestion 
became  disordered,  and  he  lost  flesh  as  well  as  intellectual  activity  and  mus- 
cular power. 

Intercourse  being  for  a  time  prevented  by  the  occurrence  of  pregnancy, 
these  first  symptoms  disappeared,  but  they  returned  some  months  after  de- 
livery, and  from  that  time  rapidly  increased.  The  use  of  nutritive  and 
abundant  food,  in  place  of  repairing  the  patient's  strength,  increased  his 
digestive  disorder;  stimulant  drinks,  taken  with  the  intention  of  assisting 
digestion,  only  excited  irritation;  severe  attacks  of  indigestion  occurred, 
and  brought  on  gastritis,  which  was  combated  by  leeches  to  the  epigastrium 
and  anus.  Obstinate  constipation  came  on,  and  after  a  time  was  succeeded 
by  diarrhoea.  Feelings  of  sufi'ocation  next  came  on,  with  palpitations,  which 
seemed  to  threaten  disease  of  the  heart.  These  symptoms  were  treated  by 
further  abstraction  of  blood.  At  the  same  time  the  patient's  venereal 
desires  grew  weaker;  his  erections  diminished;  ejaculation  took  place  more 
and  more  rapidly,  and  scarcely  excited  any  sensation.  The  acts  of  coitus 
were  several  days  apart,  and  sometimes  did  not  take  place  for  a  week  or 
fortnight. 

A  second  pregnancy  afi'orded  several  months  of  absolute  cessation  from 
intercourse  ;  but  this  time  the  patient  did  not  regain  his  health.  Nocturnal 
pollutions  had  commenced  ;  these  he  regarded  as  the  results  of  continence ; 
but  coitus,  however  rarely  practised,  always  increased  his  weakness;  the 
nocturnal  pollutions  diminished,  and  then  disappeared  entirely,  but  still  the 
palpitation  and  digestive  disorder  continued  to  increase.  The  coincidence 
of  these  circumstances  led  the  patient's  suspicions  from  the  true  cause  of 
his  disorder.  He  attributed  the  inactivity  of  his  genital  organs  to  the  ex- 
treme weakness  of  his  system,  which  he  thought  arose  from  the  leeching 
and  diet  he  had  been  subjected  to,  and,  consequently,  omitted  to  speak  of 
his  impotence  to  his  medical  attendants,  who,  on  the  other  hand,  knowing 
that  conjugal  intimacy  had  ceased,  did  not  inquire  further.  These  symp- 
toms increased,  until,  at  the  age  of  twenty-five,  the  patient  came  to  Paris. 
He  had  then  suffered  during  three  years.  The  following  were  the  symp- 
toms : — 

Excessive  emaciation  and  pallidity;  considerable  tenderness  of  the  epi- 
gastrium ;  the  abdomen  constantly  distended  by  flatus ;  tongue  red' at  its 
borders,  and  towards  the  point;  anorexia;  digestion  of  animal  food  almost 
impossible,  and  that  of  vegetable  difficult,  and  accompanied  by  flatulence 
and  flushing  of  the  face ;  obstinate  constipation  alternately  with  diarrhoea ; 


VENEREAL    EXCESSES.  163 

flatulent  colic,  often  sufficiently  alarming,  returning  at  variable  times,  and 
without  apparent  cause.  These  colics  commenced  by  rapid  distension  of 
the  stomach  with  flatus,  accompanied  with  spasm  in  its  cardiac  extremity, 
and  in  the  large  intestines,  with  oppression  at  the  diaphragm  threatening 
suS'ocation.  The  palpitations,  together  with  the  precordial  anxiety,  then 
became  doubly  severe,  sudden  congestion  in  the  head  took  place,  the  shivering 
which  had  been  present  before  gave  place  to  a  burning  heat,  followed  by 
abundant  perspiration ;  after  a  longer  or  shorter  time  a  sudden  discharge  of 
flatus  occurred,  both  by  the  mouth  and  by  the  anus,  which  was  followed  by 
softening  of  the  abdomen  and  immediate  relief.  The  general  prostration 
which  followed  these  attacks  was  proportioned  to  their  intensity  and  duration. 
At  the  same  time  the  patient  suflered  from  constant  palpitation  of  the  heart, 
increased  by  any  exertion,  by  any  excitement,  physical  or  moral,  and  espe- 
cially by  the  process  of  digestion.  The  heart's  action  was  rapid  and  irregular, 
but  not  stronger  nor  heard  over  a  greater  extent  of  the  thorax  than  natural ; 
and  there  was  neither  friction  sound,  nor  bruit  de  souffle.  The  pulse  was 
small  and  weak. 

Besides  these  symptoms,  the  patient  complained  of  general  weakness, 
especially  in  the  loins  and  legs,  of  a  sense  of  lassitude,  loss  of  memory,  fre- 
quent sighing,  irritability  on  slight  contradiction,  light,  broken,  unrefreshing 
sleep,  and  great  sensibility  to  cold  or  damp. 

These  symptoms  had  been  noticed  by  all  the  practitioners  previously  con- 
sulted. The  following  they  had  not  discovered  :  During  the  passage  of 
the  feces,  the  emission  by  the  urethra  of  a  thick,  viscid,  unctuous,  slightly 
opaque  matter;  frequent  desire  of  micturition,  the  urine  being  passed  in 
small  quantities,  and  with  little  force,  the  last  drops  thick  and  viscid  ;  and, 
after  cooling,  the  urine  being  muddy  and  fetid,  and  depositing  a  flocculent, 
thick,  whitish  sediment;  a  feeling  of  uneasiness  in  the  perineum,  with  pains 
in  the  spermatic  cord  and  testicles,  and  spasmodic  contraction  between  the 
sphincter  and  the  neck  of  the  bladder. 

After  reflection  on  these  symptoms,  I  did  not  hesitate  to  attribute  them 
to  involuntary  seminal  discharges;  and  I  accordingly  prescribed  iced  milk 
mixed  with  lime  water  or  Spa  water;  vegetable  diet;  cold  lotions  on  the 
perineum  night  and  morning,  and  before  and  after  defecation ;  an  active 
country  life,  with  often  repeated  exercise  of  short  duration. 

On  seeing  the  patient  the  following  year,  I  found  that  these  means  had 
produced  slight  improvement,  but  that  the  progress  towards  recovery  had 
been  arrested  for  some  time.  I  now,  therefore,  determined  to  try  acupunc- 
ture. This  I  performed  with  two  long  needles,  introduced  about  the  middle 
of  the  perineum,  so  as  to  traverse  the  prostate  in  the  direction  of  the  ejacu- 
latory  ducts. 

From  this  time  the  diurnal  pollutions  ceased  almost  suddenly;  a  few  noc- 
turnal emissions  then  occurred,  attended  by  dreams,  energetic  erections, 
and  acute  sensations ;  the  sexual  appetite  returned,  the  patient's  desires 
became  imperious,  and  his  re-establishment  progressed  rapidly.  During  six- 
teen years,  M.  B has  since  enjoyed  the  full  activity  of  all  his  functions 

— the  gastric  and  cardiac  symptoms  have  disappeared,  together  with  the 
diurnal  pollutions. 

The  lively  interest  which  I  took  in  this  patient,  made  me  discover, 
by  dint  of  patient  questioning,  what  had  escaped  the  other  practi- 
tioners he  had  consulted.     At  that  time  my  attention  had  not  been 


164  CAUSES    OF    SPEEMATOREHCEA. 

attracted  to  the  effects  of  diurnal  pollutions,  which  I  had  no  idea 
were  so  common  oi'  capable  of  assuming  so  serious  an  aspect.  This 
case  struck  me  forcibly  :  indeed,  I  may  say,  that  it  in  great  measure 
enlightened  me  as  to  the  cause  of  a  crowd  of  symptoms  of  the  same 
nature,  which  I  met  with  in  other  patients,  and  that  it  led  me  to 
msike  the  researches  Avhich  I  now  publish. 

In  this  case  there  was  not  the  slightest  complication.  The  first 
intercourse  took  place  at  twenty-one  years  of  age  ;  the  constitution 
was  remarkably  robust,  and  the  genital  organs  had  been  preserved 
from  all  abuse  :  thus,  the  orgasm  which  seized  them  carried  their 
activity  to  the  highest  degree,  and  all  the  economy  was  for  some 
time  in  a  state  of  active  excitement ;  all  the  functions  were  performed 
with  more  energy  ;  the  losses  caused  by  the  discharges  were  rapidly 
repaired  ;  and  health  continued  in  all  its  vigor.  How  theil  should 
danger  be  feared  ?  The  excesses  were  continued  until  the  patient's 
health  became  disordered  ;  and  now,  pregnancy  having  occurred,  he 
had  a  period  of  rest,  which  caused  these  first  accidents  to  disappear — 
showing  they  were  only  due  to  the  venereal  excesses.  A  second 
pregnancy,  however,  did  not  produce  the  same  results — diurnal  pol- 
lutions having  already  appeared.  The  local  and  general  effects  of 
these,  with  the  errors  of  treatment  that  followed  them,  I  need  not 
comment  on. 

Milk  diet  and  exercise  produced  slight,  but  very  slow  improvement, 
which  had  entirely  ceased  when  I  saw  the  patient  a  year  afterwards. 
The  same  results  did  not  take  place  after  acupuncture  ;  its  action  was 
rapid,  and  its  results  lasting.  The  spasmodic  contractions  experi- 
enced in  the  perineum,  or  rather  between  the  bladder  and  rectum, 
that  is  to  say,  in  the  seminal  vesicles,  induced  me  to  try  this  remedy. 
It  struck  me  that  these  symptoms  were  purely  nervous,  and  that 
habit  had  a  good  deal  to  do  with  their  persistence.  Success  attended 
their  trial,  and  the  prompt  action  of  the  remedy  can  only  be  explained 
by  the  nervous  disorder  which  it  caused  in  the  parts.  Such  a  result 
made  me  hope  much  from  the  effects  of  acupuncture,  in  cases  of 
spermatorrhoea,  but  it  has  succeeded  in  only  a  few  ;  and  by  com- 
paring the  symptoms,  the  reason  of  this  apparent  anomaly  is  evident, 
seeing  that,  in  most  cases,  diurnal  pollutions  are  kept  up  by  chronic 
inflammation,  or  acute  irritation  of  the  parts,  and  to  remove  this  the 
operation  has  no  power.  Acupuncture,  too,  does  little  good  in  cases 
of  atony  of  the  ejaculatory  canals  ;  so  that  there  only  remain  such 
cases  as  are  due  to  a  purely  nervous  state,  or  a  habit  of  spasm,  and 
these  are  by  far  the  least  frequent.  To  these  may  be  added  cases 
in  which  the  nervous  disorder  persists  after  the  removal  of  the  irri- 
tation, but  these  are  still  more  rare. 

I  have,  at  present,  before  me,  the  memoir  of  a  master  of  a  school, 
who  married  very  young,  after  having  resisted  all  temptation  to  bad 
habits,  but  who  yielded,  as  in  the  preceding  case,  to  immoderate  in- 
tercourse, of  which  he  soon  felt  the  effects  on  his  health.  This  patient 
took  nutritive  food  to  keep  up  his  strength,  and  stimulant  drinks  to 


VENEEEAL   EXCESSES.  165 

assist  his  digestion.  An  attack  of  gastritis  resulted,  ^vhich  -was 
treated  by  leeches,  baths,  and  vegetable  diet.  Two  months  passed 
in  an  excursion  to  the  mountains,  re-established  his  health,  but  on 
his  return  he  relapsed  into  the  same  state ;  constipation  supervened, 
and  his  intellect  was  weakened.  Three  times,  however,  he  obtained 
considerable  benefit  during  the  vacations,  which  he  passed  away 
from  his  wife,  but  at  last,  nocturnal  pollutions  commenced,  and  he 
was  obliged  to  resign  his  occupation.  This  case  resembles  the  one 
just  related,  except  that  the  head  and  stomach  were  the  organs 
chiefly  affected. 

Simple  cases  like  these  are  very  common  :  they  were  even  de- 
scribed by  Hippocrates  ;  but,  however  common  they  may  be,  they 
are  very  serious,  and  of  much  importance  to  society  generally. 


CASE  XXXVII. 

Robust  constitution — Venereal  excesses  continued  till  the  age  of  twenty-four 
—  Chronic  Inflammation  of  the  bladder — A^octurnal  and  diurnal  j^ollu- 
tions — Cauterization  followed  by  perfect  recovery. 

Dr.  D ,  short,  dark,  and  robust,   of  a  lively  disposition,  and  much 

addicted  to  sexual  intercourse,  practised  great  excesses,  which  he  some- 
times carried  so  far  as  to  cause  eruissiou  of  blood.  His  health  became 
disordered,  his  desires  diminished,  and  at  length  ceased  entirely.  Notwith- 
standing absolute  continence,  his  condition  daily  grew  worse,  and  when  he 
came  to  consult  me,  in  1832,  at  the  age  of  twenty-five,  he  presented  the 
following  symptoms  :  great  emaciation ;  face  pale  and  sad ;  eyes  sunken  ; 
urine  passed  from  twenty  to  thirty  times  a  day,  and  its  discharge  attended 
by  scalding  and  lancinating  pains  in  the  neck  of  the  bladder,  the  stream 
small,  weak,  and  crooked,  and  the  last  drops  passed  with  difficulty,  inducing 
spasmodic  contractions  of  the  neck  of  the  bladder,  and  the  expulsion  of  a 
thick  viscid  matter,  which  stopped  at  the  orifice  of  the  canal  j  the  urine 
abundant  in  quantity,  muddy,  and  sometimes  containing  blood,  always  de- 
composing rapidly,  exhaling  a  disagreeable  smell,  and  throwing  down  an 
abundant  deposit  of  thick  and  flocculent  matter  ;  a  feeling  of  weight  in  the 
rectum,  and  at  the  margin  of  the  anus ;  spasmodic  contraction  of  the  sphinc- 
ters ;  habitual  and  obstinate  constipation,  notwithstanding  the  repeated  use 
of  lavements ;  defecation  difficult  and  painful,  and  causing  the  expulsion, 
by  the  urethra,  of  more  or  less  viscid  matter  resembling  semen  (this  was 
easily  observed  by  emptying  the  bladder  before  going  to  stool) ;  the  passage 
of  flatus  sometimes  produced  a  similar  evacuation,  but  less  abundant ;  the 
nocturnal  pollutions,  frequent  at  first,  had  been  rare  during  several  months  ; 
pain  in  the  testicles  and  spermatic  cord,  diminishing  by  the  use  of  a  sus- 
pensory bandage ;  digestion  difficult,  and  accompanied  with  the  develop- 
ment of  flatus,  griping  pains,  and  flushing  of  the  face ;  loss  of  memor}' ; 
intellectual*  excitement  producing  headache,  dizziness,  and  noise  in  the  ears  ; 
restlessness,  contrasting  strongly  with  the  weakness  of  the  lower  extremities; 
sleep  unsound,  and  often  broken  by  calls  to  micturate ;  lassitude  greater  in 
the  morning  than  in  the  evening ;  catheterism  very  painful  from  excessive 
sensibility  and  spasmodic  contraction  in  the  neck  of  the  bladder. 
11 


166  CAUSES    OF    SPERMATOREHCEA. 

From  these  symptoms  I  proposed  cauterization,  which  waa  performed 
rapidly  over  the  neck  of  the  bhidder,  and  more  slowly  over  the  mucous 
surface  of  the  prostate;  the  pain  was  very  severe,  but  diminished  very 
quickly.  The  immediate  effects  of  the  operation  presented  nothing  unusual; 
long-continued  baths,  abundant  drinks,  and  repeated  injections,  sufficed  to 
relieve   the  inflammation   produced.     From  that  time  I  lost  sight  of  Dr. 

D ,  until  one  day  I  met  him  accidentally  ;  he  was  so  changed  that  I 

talked  to  him  some  time  without  recognition.  His  face  was  red  and  healthy- 
looking,  his  voice  loud  and  sonorous,  and  he  had  grown  stout  to  a  degree 
uncommon  at  the  age  of  twenty-seven  ;  his  return  to  health  had  been  slow, 
but  progressive,  and  was  perfected  without  the  use  of  any  other  treatment 
than  the  cauterization.  He  bore  cold  and  damp  with  impunity,  although, 
previousl}',  he  had  always  been  very  sensitive  to  them,  and  all  his  functions, 
without  exception,  were  performed  as  well  as  before  his  illness. 

In  this  case,  an  affection  of  the  urinary  organs  acconapaniecl  that 
of  the  spermatic,  and  the  seminal  vesicles  were  probably  in  a  condi- 
tion similar  to  that  of  the  bladder  ;  indeed,  the  excesses  had  been 
several  times  carried  so  far  as  to  cause  emission  of  blood  ;  abnormal 
irritability  existed  in  the  prostatic  portion  of  the  urethra  ;  the  sper- 
matic cords  and  the  testicles  were  the  frequent  seat  of  pain.  The 
irritation,  therefore,  passed  through  the  ejaculatory  ducts  and  semi- 
nal vesicles,  to  the  spermatic  cords  and  testicles. 

To  this  irritation  the  nocturnal  and  afterwards  the  diurnal  pollu- 
tions must  be  attributed.  The  constipation,  too,  undoubtedly  fa- 
vored the  occurrence  of  pollutions  during  defecation  ;  but  the  con- 
stipation itself  arose  from  the  irritation  in  the  prostatic  region,  as 
was  indicated  by  the  spasmodic  contraction  of  the  sphincters,  and  the 
sensation  of  weight  in  the  neighborhood  of  the  rectum,  and  at  the 
margin  of  the  anus.  All  the  symptoms  disappeared  after  cauteriza- 
tion— another  proof  that  they  all  arose  from  the  same  cause. 

In  these  two  cases,  venereal  excesses  acted  alone  in  the  produc- 
tion of  spermatorrhoea.  In  the  cases  I  am  about  to  relate,  such 
excesses  were  complicated  with  other  causes. 

CASE  XXXVIII. 

Three  attacks  of  Uennorrhagia — ni/poclioiulriasis — Danger  of  sulcuh: 
— Recovery — Marriage  a  few  months  after — Change  in  the  moral 
faculties — Disordered  digestion — Constipation — Agitation — Insomnia — 
Fits  of  passion — Si/mptoms  of  mental  derangement — Impotence — i^x/c- 
turnal  and  diurnal  pullntions — Cauterization  followed  hy  rapid  recovery — 
Excesses  repeated — Relapse. 

M.  N ,  of  strong  constitution,  and  sanguineous  temperament,  passed 

his  childhood  without  suffering  from  any  disease,  and  attained  a  tall  stature 
and  an  unusual  amount  of  strength.  He  rarely  practised  masturbation,  and 
seldom  had  intercourse  with  women :  at  the  age  of  twenty,  he  contracted 
blennorhagia,  which  was  cured  in  a  month  by  the  use  of  copaiba.  At  the 
age  of  twenty-three,  he  had  a  second  attack,  which  was  treated  like  the 


VENEREAL    EXCESSES.  167 

first,  and  cured  in  six  weeks.  At  the  age  of  thirty,  a  third  attack  occurred ; 
this  was  treated  by  the  same  means,  and  cured  in  about  the  same  time. 

From  this  period,  M.  N experienced  frequent  desire  to  make  water, 

and  only  passed  a  small  quantity  at  a  time ',  his  digestion  became  dis- 
ordered ;  constipation  supervened ;  his  venereal  desires  diminished ;  his 
sleep  was  disturbed  and  unquiet ;  and  his  character,  previously  very  gay, 
completely  changed.  By  degrees,  he  entirely  separated  himself  from  his 
friends ;  he  sought  solitude,  and  read  only  the  most  serious  books.  At 
length,  he  seemed  pursued  by  an  almost  irresistible  desire  to  commit  suicide. 
His  father  having  perceived  this,  took  him  to  Paris,  Switzerland,  &c.,  ia 
the  hope  that  he  would  be  benefited  by  change  of  scene ;  but  whenever  he 
passed  over  a  bridge  or  near  a  lake,  or  any  precipitous  place,  he  felt  a  desire 
to  throw  himself  down.     But  these  symptoms  passed  off  by  degrees,  and  at 

the  end  of  six  months,  M.  N resumed  his  duties  as  a  notary,  although 

he  showed  a  somewhat  dreamy  air  occasionally.  Eighteen  months  afterwards 
he  married,  at  the  age  of  thirty-two.  Sexual  intercourse  took  place  twice  a 
day  for  some  time,  but  always  very  rapidly.     At  the  end  of  three  months, 

M.  N experienced  a  great  desire  for  motion  and  change,  and  considerable 

agitation.  He  sometimes  showed  an  extraordinary  degree  of  gayety,  but  the 
least  contradiction  threw  him  into  a  terrible  passion.  His  actions  and  his 
conversation  had  something  strange  about  them.  He  even  felt  this  himself, 
and  frequently  exclaimed,  "Absurd  !  I  am  losing  my  senses;  I  am  becoming 
a  fool."  His  wife  became  pregnant,  and  afterwards  suffered  from  peritonitis; 
hence  a  long  suspension  of  intercourse  took  place,  with  remarkable  improve- 
ment in  M.  N 's  health.  But  after  a  few  returns  of  intimacy,  his  diges- 
tion again  became  deranged,  and  his  constipation  returned  and  became  more 
and  more  obstinate.  A  second  pregnancy,  by  preventing  intercourse,  pro- 
duced the  same  results  as  the  first.  But  on  again  resuming  intimacy,  an 
indefinable  sense  of  uneasiness  came  on  in  the  patient's  abdomen,  which  was 
habitually  distended  with  flatus  ;  he  frequently  complained  of  cramps ;  of 
pressure  in  the  chest ;  of  difiiculty  of  breathing,  and  palpitation.  He  felt 
suffocating;  his  head  was  hot;  his  face  red  and  injected;  his  mind  disordered — 
he  constantly  repeated  "  that  he  was  lost."  At  times  he  rolled  about  and 
tore  his  clothes,  and  when  in  these  paroxysms,  there  was  considerable  diffi- 
culty in  preventing  him  from  doing  himself  injury,  and  from  breaking 
everything  within  his  reach.  Friction  on  the  limbs  and  abdomen,  and 
warmth,  appeared  to  relieve  the  fits.  When  they  were  over,  the  patient 
shed  tears  in  abundance,  and  shut  himself  up  for  a  long  time,  without  seeing 
any  one.  Such  attacks  became  daily  more  frequent,  and  were  sometimes 
repeated  several  times  a  day. 

A  remarkable  change  also  occurred  in  M.  N 's  intellect ;  his  memory 

and  power  of  composition  diminished,  and  he  was  obliged  to  give  up  his 
profession.  His  writing  even  became  changed,  and  was  almost  illegible. 
He  neglected  music,  previously  his  favorite  amusement,  and  his  voice  lost 
its  brilliancy  and  correctness  of  tone.  He  was  generally  taciturn,  though 
sometimes  he  showed  extraordinary  loquaciousness,  and  his  conversation 
was  unconnected.  Being  unable  to  sleep,  he  rose  often  in  the  night,  and 
walked  about  the  room  nearly  naked,  and  if  kept  in  bed  by  force,  he  tossed 
about,  complained  of  suffocation,  and  demanded  every  minute  what  time  it 
was. 

These  symptoms  seemed  to  point  out  a  case  of  insanity.     The  patient  was 
bled  several  times,  and  leeches  were  applied  to  the  epigastrium  and  anus ; 


168  CAUSES    OF    SPERMATOERHCEA. 

but  abstraction  of  blood  only  aggravated  his  condition.  Injections  did  not 
relieve  his  constipation ;  five  or  six  were  sometimes  necessary  to  procure  an 
evacuation. 

The  patient's  linen  being  constantly  stained  by  semen,  sometimes  mixed 
with  blood,  his  attention  was  attracted  to  the  genital  organs ;  and  he  soon 
discovered  that  he  had  frequent  nocturnal  pollutions,  without  erection  or 
sensation.  He  immediately  informed  his  medical  attendant  of  this  fact,  and 
that  gentleman  further  discovered  the  presence  of  diurnal  pollutions,  both 
while  at  stool  and  during  the  emission  of  urine.  He  accordingly  sent  M. 
N to  consult  me. 

I  found  the  patient's  urine  thick  and  muddy,  and  containing  a  considera- 
ble deposit  of  semi-transparent  granules,  resembling  grains  of  rice.  I  was 
unable  to  ascertain,  certainly,  the  presence  of  seminal  discharge  during 
defecation,  but  nocturnal  pollutions  occurred  almost  every  night ;  the  dis- 
charge was  very  abundant,  and  often  mixed  with  blood.  On  the  30th  of 
December,  therefore,  I  performed  cauterization  from  the  neck  of  the  bladder 
as  far  as  the  membranous  portion  of  th«  urethra. 

During  five  days,  the  urine  was  bloody;  the  patient's  agitation  was 
increased,  and  other  accidents  occurred,  but  from  the  sixth  to  the  fifteenth 
day  these  symptoms  rapidly  diminished.  The  stools  became  more  regular ; 
the  urine  transparent,  and  the  patient's  sleep  sound  and  refreshing.  Ene- 
mata  were,  from  this  time,  no  longer  necessary ;  the  patient's  bowels  acted 
freely  every  day ;  his  appetite  increased ;  digestion  was  rapid  ;  and  his 
sleep  became  daily  longer  and  more  deep;  the  patient  hastened  to  bed  at 
night,,  and  rose  late ;  he  seemed  to  be  in  a  state  of  narcotism  from  six  at 
night  till  nine  or  ten  in  the  morning.  .  By  degrees,  however,  this  desire  to 
sleep  diminished ;  the  patient  rose  early  in  the  morning,  walked  all  the  day, 
and  went  into  society  in  the  evening ;  he  wrote  well  expressed  and  sensible 
letters;  his  character  resumed  its  gayety ;  and  he  was  tormented  by  venereal 
desires. 

Six  weeks  after  the  cauterization,  all  his  functions  were  re-established; 
no  discharge  appeared  in  his  urine;  the  nocturnal  pollutions  no  longer  took 
place,  and  no  pollutions  occurred  during  defecation.  On  the  12th  of  Feb- 
ruary, the  patient  returned  to  his  family. 

When  M.  N quitted  Montpellier  his  health  Avas  quite  re-esta- 
blished: I  dreaded  his  return  to  bis  wife,  but  I  was  obliged  to  yield 
to  the  impatience  of  his  relatives,  after  having  explained  to  them  the 

origin  of  my  fears.     M.  N himself  promised  the  utmost  reserve, 

and  for  a  short  time  he  kept  his  word ;  but  he  soon  committed  further 
excesses  which  the  irritable  state  of  his  organs  would  not  bear,  and 
at  the  expiration  of  two  months,  a  change  again  commenced  in  his 
character.  The  nocturnal  pollutions  reappeared,  together  with  most 
of  his  former  symptoms.  Three  months  later,  the  patient  again 
visited  Montpellier. 

From  the  time  of  the  cauterization,  his  stools  had  continued  free 
and  regular  ;  his  sleep  had  been  sound  ;  his  appetite  large  ;  and  his 
digestion  regular.  He  daily  took  long  walks.  His  condition,  there- 
fore, was  by  no  means  so  bad  as  at  first ;  yet  the  nocturnal  pollutions 
were  repeated  four  or  five  times  a  week,  and  were  very  abundant;  his 


VENEREAL    EXCESSES.  169 

intellect  was  much  disordered;  and  his  speech  was  rendered  difficult 
bj  a  very  decided  stammering. 

I  performed  cauterization  a  second  time,  but  its  effects  were  nei- 
ther so  marked  nor  so  lasting.  The  period  for  the  mineral  waters 
having  arrived,  I  recommended  the  use  of  those  at  Aix  in  Savoy, 
both  in  baths  and  douches.  I  learned  afterwards,  that  these  means 
were  employed  without  success ;  and  that  the  disorder  of  the  pa- 
tient's intellect  continued  gradually  to  increase. 

This  case  much  resembles  that  of  M.  De  S ,  which  I  have 

related  in  my  second  chapter,  page  37. 

I  have  before  me  the  histories  of  many  cases  like  the  preceding. 
I  shall  not  report  them  in  detail,  because  they  are  less  characteristic 
and  less  serious  than  that  of  M.  N ,  and  because  I  have,  in  a  for- 
mer chapter,  spoken  of  the  influence  exercised  by  blennorrhagia  in 
producing  irritation  of  the  spermatic  organs.  The  following  is  a 
summary  of  the  chief  symptoms  presented  by  such  patients  as  have 
come  under  my  care  : — 

After  having  had  one  or  more  attacks  of  blennorrhagia,  more  or 
less  easily  cured,  the  patients  continued  in  good  health  so  long  as 
they  contracted  no  permanent  liaisons.  In  some  of  my  patients,  dis- 
ordered health  caused  such  liaisons  to  be  broken  off,  the  health  be- 
coming re-established  by  a  prolonged  continence  ;  after  which,  slight 
intercourse  again  caused  an  obstinate  urethral  discharge.  After 
having  led  a  regular  life  for  some  time,  such  patients  believed  them- 
selves sufficiently  well  to  marry ;  but  after  a  longer  or  shorter  time, 
their  health  became  deranged,  although  they  did  not  think  themselves 
committing  excesses.  By  degrees,  the  intercourse  became  less  fre- 
quent, the  act  very  rapid,  and  after  a  time,  quite  impossible. 

In  all  these  patients,  the  impotence  was  the  result  of  diurnal  pol- 
lutions which  had  been  sometimes  preceded  by  nocturnal  pollutions. 
The  diminution  of  virility  is  attributed,  by  such  patients,  to  their 
disordered  health,  to  the  regimen,  or  treatment  employed  to  cure  an 
attack  of  gastritis,  of  irritation  in  the  chest,  of  palpitation,  cerebral 
congestion,  or  of  commencing  disease  of  the  medulla  spinalis,  accord- 
ing as  such  or  such  symptoms  have  predominated.  Not  only  are 
the  patients  ignorant  that  their  state  arises  from  diurnal  pollutions, 
but  I  have  even  found  it  difficult,  in  many  cases,  to  make  them 
believe  that  such  is  the  case,  because  they  have  always  thought 
themselves  very  moderate  in  their  sexual  intercourse. 

If  these  observations  be  compared  with  those  related  in  my  second 
chapter  ;  and  if  the  pain  and  swelling  which  these  patients  felt  in 
the  spermatic  cord  and  testicles  when  they  have  not  had  severe 
attacks  of  orchitis  following  blennorrhagia,  be  taken  into  considera- 
tion ;  it  will  be  evident  that  such  inflammations  may  leave  a  parti- 
cular susceptibility  in  the  mucous  membrane  of  the  genital  organs, 
which  only  awaits  an  exciting  cause  for  its  development :  that  slight 
excitement  from  sexual  intercourse,  rather  frequently  repeated,  may 
set  up  an  irritation  in  the  tissues  which  the  same  act  would  not  have 


170  CAUSES    OF    SPERMATORRHOEA. 

produced  before  the  organs  were  thus  affected ;  and  lastly,  that 
these  tissues  not  being  in  the  same  condition,  the  individual  must 
not  reason  from  what  he  was  able  to  do  previously,  to  know  whether 
he  is  committing  excesses,  or  whether  he  is  still  within  the  limits  of 
his  powers. 

It  thus  becomes  evident,  why  the  most  serious  and  obstinate 
svmptoms  are  developed  after  marriage. 

I  have  already  shown  that  masturbation  may  produce  the  same 
immediate  effects  on  the  spermatic  organs  as  the  most  violent  blen- 
norrhagia;  I  now  proceed  to  show,  that  under  similar  circumstances, 
it  may  predispose  to  exactly  similar  remote  results. 

CASE  XXXIX. 

Strong  constitution — Mastiirhation  at  the  age  of  seventeen — Se7-ious  disorder 
of  the  health,  until  ticenfy-six — Marriage — Rapid  improvement — Gra- 
dual relaj)se  after  three  years,  notv:ithstanding  the  cessation  of  coitus — 
Seminal  discharges  during  defecation  and,  the  emission  of  urine — Hypo- 
chondriasis— Infiammation  of  the  genito-urinary  organs — Cauterization 
— Rapid  and  complete  cure. 

M.  C ,  a  land  surveyor,  of  sanguineous  temperament  and  large  frame, 

practised  masturbation  with  such  fury  that  he  brought  on  vomiting  of  blood, 
and  became  exceedingly  weak,  pale,  sallow,  and  much  emaciated.  At  the 
age  of  twenty  his  extreme  weakness,  notwithstanding  his  height  and  the 
size  of  his  frame,  made  him  reform  after  three  unsuccessful  attempts.  He 
relapsed,  however,  and  the  same  cause  continuing,  during  six  years  his 
health  was  much  disordered.     At  the  age  of  twenty-six  he  married. 

During  two  years,  intercourse  took  place  daily,  and  frequently  several 
times  a  day,  yet  the  patient's  health  improved  rapidly,  and  his  vigorous  con- 
stitution reached  all  the  development  of  which  it  was  capable. 

In  the  course  of  the  third  year  he  perceived  that  his  health  became  gra- 
dually disordered,  and  shortly  after  he  noticed  that  he  passed  small  quan- 
tities of  semen  while  at  stool.  Soon  the  semen  passed  in  larger  quantities, 
and  his  health  became  more  and  more  disordered.  At  length,  obstinate 
constipation  supervened,  which  rendered  the  seminal  discharges  still  more 
abundant.     They  were  accompanied  with  a  slight,  not  unpleasant  sensation. 

The  patient  experienced  a  constant  itching  in  the  scrotum  and  perineum, 
although  there  was  no  appearance  of  eruption,  and  felt  a  sort  of  creeping 
which  extended  towards  the  bladder  and  the  root  of  the  penis.  His  diges- 
tion was  difficult,  and  attended  by  the  development  of  flatus,  and  his  sto- 
mach could  only  retain  very  light  food,  in  very  small  quantities ;  his  sleep 
was  short,  and  disturbed  by  frightful  dreams,  and  on  waking  he  felt  lassi- 
tude, soreness  of  his  limbs  and  depression  of  spirits;  during  the  day  his 
thoughts  were  sad — he  presented,  in  fact,  all  the  symptoms  of  confirmed 
hypochondriasis. 

He  felt  a  constant  desire  to  walk,  but  was  soon  tired ;  he  bungled  in  his 
professional  operations,  lost  his  memory,  and  performed  the  most  trifling 
calculations  with  difficulty. 

When  M.  C came  to  consult  me  in  the  beginning  of  August,  1824, 

he  had  relapsed  into  nearly  the  same  condition  as  before  his  marriage.     He 


VENEREAL    EXCESSES.  171 

had,  however,  totally  abstained  from  sexual  intercourse  for  more  than  a 
year,  because  his  venereal  desires  and  erections  had  almost  ceased.  The 
orifice  of  the  urethra  was  injected  and  irritable ;  the  scrotum  flaccid,  and 
the  testicles  large  but  soft.  The  urine  was  passed  often  and  with  difficulty ; 
the  first  jet  requiring  considerable  efforts  for  its  expulsion ;  the  last  drops 
caused  spasmodic  contractions  in  the  bladder  and  neighboring  parts,  and 
were  thick  and  viscid,  appearing  like  a  thick  solution  of  gum.  The  patient 
felt  as  if  something  always  remained  in  his  bladder.  The  urine  was  usually 
red  and  fetid ;  it  deposited  a  thick  flocculent  cloud,  which  was  sometimes 
accompanied  with  glairy  matter,  like  white  of  egg. 

These  deposits  I  believed  to  contain  semen,  vesical  mucus,  and  prostatic 
fluid,  and  their  presence  in  the  urine  seemed  due  to  chronic  inflammation  of 
the  mucous  membrane  lining  the  prostate  of  the  neck  of  the  bladder.  The 
seminal  discharges  during  defecation  were  more  abundant  than  ever.  These 
alone  would  have  been  quite  sufiicient  to  account  for  the  patient's  state. 

I  proposed  cauterization  as  the  best  means  of  altering  the  condition  of 
the  affect-ed  tissues;  and  the  patient  consented.  On  introducing  the  ca- 
theter I  found  the  canal  extremely  sensitive  ;  the  spasms  were  so  severe, 
especially  on  approaching  the  neck  of  the  bladder,  that  the  whole  of  M. 

C 's  body  was  covered  with  a  profuse  sweat,  and  I  found  it  necessary  to 

delay  the  cauterization.  Three  days  afterwards  the  same  catheter  was  in- 
troduced with  much  less  pain,  and  the  urine  having  been  completely  eva- 
cuated I  cauterized  the  bladder  near  its  neck,  and  the  prostatic  and  mem- 
branous portions  of  the  urethra.  The  operation  was  performed  rapidly,  and 
scarcely  gave  more  pain  than  the  introduction  of  the  catheter;  but  it  caused 
a  kind  of  very  acute  pinching  pain  at  the  margin  of  the  anus  and  in  the 
rectum. 

Soon  after  the  operation  the  patient  experienced  a  feeling  of  strength  in 
the  genito-urinary  organs,  which  increased  as  the  pain  passed  off.  The  con- 
stipation ceased  spontaneously;  the  urine,  by  degrees,  regained  its  color  and 
transparency,  and  at  the  end  of  the  thirteen  days  the  patient  was  compelled 
to  return  home.  The  journey  (about  sixty  miles)  did  not  produce  any  of 
the  inconveniences  I  had  feared ;  and  two  months  afterwards  I  received  a 

letter  from  M.  C ,  stating  that  he  was  perfectly  well,  and  had  recovered 

his  strength,  and  the  perfect  use  of  all  his  functions. 

This  patient  was  not  more  moderate  in  sexual  intercourse  than  he 
had  previously  been  in  his  bad  habits  ;  yet  marriage  benefited  his 
health.  This  change,  which  lasted  three  years,  shows  the  great 
difference  that  exists  between  the  effects  of  sexual  intercourse  and 
masturbation. 

Why  did  not  this  improvement  continue  ?  Simply  because  the 
frequency  of  the  acts  exceeded  the  real  wants  of  the  patient ;  and 
because  the  organs  had  previously  been  weakened  by  serious  and 
long-continued  abuse.  This  circumstance  is  enough  to  show  how 
complicated  the  important  question  of  marriage  becomes  in  such 
cases.  I  shall  by  and  by  relate  some  others  which  will  perhaps 
make  those  pause  and  reflect,  who  thoughtlessly  recommend  so  se- 
rious an  engagement  as  a  remedy  for  masturbation. 

Was  there  any  semen  in  the  urine  in  this  case  ?  The  quantity  of 
vesical  mucus  and  of  the  prostatic  secretion  did  not  permit  of  a 


172  CAUSES    OF   SPERMATOERHOEA. 

certain  decision  on  this  point.  The  last  drops  passed  from  the 
urethra  were  viscid,  like  solution  of  gum,  and  abundant  seminal  dis- 
charges took  place  during  defecation.  In  cases  of  this  nature  it  is 
evident  that  chronic  inflammation  extends  from  the  mucous  surface 
of  the  prostate  to  the  neighboring  tissues ;  cauterization  is  a  certain 
means  of  getting  rid  of  this  with  all  the  symptoms  depending  on  it. 
Whether  there  be  or  be  not  semen  in  the  urine,  the  indication  is 
always  the  same. 

I  have  more  than  once  referred  to  the  connection  that  exists 
between  the  neck  of  the  bladder  and  the  anus;  this  patient  showed 
it  in  a  high  degree.  At  the  moment  of  the  cauterization  he  com- 
plained  of  a  severe  pinching  pain  in  the  rectum  and  at  the  margin 
of  the  anus  ;  and,  in  proportion  as  the  inflammation  was  dispersed, 
the  sphincters  became  relaxed  and  the  constipation  ceased  sponta- 
neously. 

CASE  XL. 

Sanguineous  temperament — Masturhation  from  fourteen  to  eighteen  years 
of  age — Marriage  at  nineteen — Immediate  improvement  in  the  health 
— Aftericards,  disorder  of  the  system — Hypochondriasis — Inclination  to 
suicide — Symptoms  of  chronic  gastritis ,  treated  for  six  years  with  leeches, 
blisters,  &c. — Nocturnal  and  diurnal  pollutions — Frequent  discharge  of 
urine — Cauterization  followed  by  rapid  and  complete  cure. 

M.  C ,  of  sanguineous  temperament  and  robust  constitution,  at  the 

age  of  fourteen  was  five  feet  six  inches  in  height,  and  of  great  muscular 
strength  :  at  this  time  be  contracted  the  habit  of  masturbation  at  school, 
and  continued  it  till  the  age  of  eighteen.  At  nineteen  he  married,  although 
he  was  very  thin,  and  weakened  by  his  previous  abuses ;  but  he  regained 
his  strength  by  degrees,  and  applied  himself  to  agricultural  pursuits  with 
energy  and  success.  He  had  two  healthy  children,  the  first  years  after  his 
marriage. 

Nevertheless,  although  he  had  no  cause  for  trouble,  the  patient's  character 
changed  by  degrees.  His  gayety  and  activity  diminished,  together  with  his 
strength  and  appetite.  Sexual  intercourse  became  less  frequent.  He  suf- 
fered from  nocturnal  pollutions — rare  at  first,  but  afterwards  more  frequent. 
His  stomach  became  disordered.  He  was  constipated ;  his  feces  were  fre- 
quently streaked  with  blood,  and  during  the  straining  necessary  for  their 
expulsion,  he  passed  a  considerable  quantity  of  matter  by  the  urethra,  which 
he  recognized  as  badly  formed  semen.  He  became  careless,  indolent,  and 
timid;  he  neglected  his  aifairs,  and  even  the  management  of  his  farm.  His 
aflfection  for  his  wife  and  children  diminished,  and  at  length  he  fell  into  a 
profound  state  of  hypochondriasis,  and  thought  of  nothing  but  his  health. 

For  sis  years  he  was  treated  for  a  supposed  gastritis  by  the  application  of 
leeches,  blisters,  and  issues ;  he  was  sent  to  the  mineral  waters,  &c.  He 
spoke  of  his  seminal  discharges  to  all  the  practitioners  he  consulted,  but 
they  were  attributed  to  the  gastritis,  or  his  continence,  even  although  he 
asserted  that  they  were  the  cause  of  what  he  suffered.  At  length,  at  the 
age  of  thirty-five,  he  was  sent  to  me  by  a  young  surgeon — one  of  his 
friends.     He  was  then  in  a  deplorable  state  of  mind;  his  constipation  was 


VENEREAL    EXCESSES.  173 

obstinate,  notwithstanding  the  habitual  and  immoderate  use  of  enemata  ; 
spermatic  discharges  occurred  during  defecation  ;  micturition  was  repeated 
as  often  as  fifteen  or  twenty  times  a  day  ;  the  stream  was  feeble  and  broken, 
and  the  excretion  abundant  and  pale,  generally  containing  a  flocculent  de- 
posit. Nocturnal  pollutions  were  frequent,  and  always  occurred  when  the 
patient  lay  on  his  back,  on  which  account  he  contrived  a  piece  of  wood  to 
be  fixed  along  the  spine,  to  prevent  him  from  assuming  that  posture.  Ca- 
theterism  was  exceedingly  painful. 

I  cauterized  the  urethra  from  the  neck  of  the  bladder  as  far  as  the  bulb. 
The  ordinary  immediate  effects  took  place;  at  the  end  of  eight  days,  the 
inflammation  had  nearly  subsided,  and  the  erections  were  violent  and  pro- 
longed without  pollutions ;  the  patient's  appetite  returned ;  his  digestion  im- 
proved ;  his  constipation  diminished ;  his  sleep  became  sound  and  healthy ; 
his  strength  increased;  and  the  emission  of  urine  became  less  frequent. 
Within  a  fortnight,  his  erections  had  become  importunate  during  the  day, 
and  almost  constant  at  night,  attended  with  erotic  dreams,  but  no  pollutions 
occurred  after  the  cauterization.  Kecovery  of  strength  was  rapid ;  and  the 
desire  of  occupation  and  business  returned.  The  patient  went  home  on  the 
twenty-second  day. 

Four  months  afterwards,  M.  C wrote  to  ask  me  if  he  need  go  to  the 

mineral  waters  as  I  had  recommended  him;  he  did  not  think  it  necessary, 
his  health  and  strength  being  completely  re-established. 

This  case  scarcely  differs  from  the  preceding ;  I  shall,  therefore, 
only  call  attention  to  the  obstinacy  with  which  the  supposed  gas- 
tritis was  treated.  It  is  difficult  to  form  an  idea  of  the  tortures 
which  this  patient  suffered  during  six  years,  or  of  the  variety  of  means 
which  were  put  in  practice  to  combat  his  disease.  Of  these,  abstrac- 
tion of  blood,  by  increasing  his  debility,  and  the  application  of  blis- 
ters, by  the  action  of  the  cantharides  on  the  genito-urinary  organs, 
did  the  patient  most  injury. 

CASE  XLI. 

JV^ervoiis  temperament  —  Delicate  health — Masturhation  he/ore  puherfy — 
Urethral  discharge  after  sexual  intercourse — Orchitis — Nocturnal  pollu- 
tions— Absolute  impotence — Injections  icith  solution  of  nitrate  of  silver 
unsuccessful — Cauterization  followed  hy  rapid  cure. 

M.  S- ,  a  doctor  of  medicine,  short  and  thin,  and  of  a  nervous  tempera- 
ment, was  subject,  from  infancy,  to  various  nervous  diseases.  He  was 
addicted  to  masturbation  long  before  puberty,  which  occurred  at  twelve 
years  of  age,  and  he  continued  the  practice  until  the  age  of  sixteen.  At 
this  period  he  had  sexual  intercourse,  and  after  several  weeks  of  daily  con- 
nection, an  abundant  discharge  came  on,  which  he  neglected  for  a  long 
time.  On  returning  to  school,  he  felt  pain  in  the  right  testicle,  followed  by 
.acute  inflammation,  with  considerable  swelling  of  the  spermatic  cord.  This 
was  relieved  by  the  usual  means.  The  following  year  he  experienced 
acute  pain  in  the  same  situation,  with  a  dragging  sensation  in  the  spermatic 
cord.  These  symptoms  diminished  by  the  use  of  a  suspensory  bandage, 
but  the  epididymis  permanently  acquired  nearly  double  its  normal  size  ; 
the   vas  deferens  continued  very  sensitive,  and  the  urethra  was  irritable. 


174  CAUSES    OF    SPERMATOEEHCEA. 

From  that  date,  darting  pains,  accompanied  py  spasms,  were  felt  in  the 
prostatic  region  during  micturition,  especially  whilst  discharging  the  last 
drops.  Sexual  intercourse  always  left  a  sense  of  weight  and  heat  in  the 
organs. 

Before  the  occurrence  of  the  urethral  discharge,  nocturnal  pollutions  had 
happened  several  times :  these  afterwards  became  more  frequent,  and  after 
a  time  they  took  place  without  erection,  motion,  or  sensation.  During  two 
years,  the  patient's  erections  grew  less  frequent  and  daily  more  imperfect, 
and  at  length  ceased  altogether. 

M.  S for  a  long  time  treated  the  pollutions  by  hygienic  means  alone  ; 

contrary  to  his  expectations,  he  found  that  a  very  hard  bed  invariably  pro- 
duced them,  and  that  they  were  increased  by  any  fatigue,  especially  by 
pedestrian  exercise.  He  also  found  himself  much  worse  after  cold  bathing. 
These  circumstances  made  him  suspect  that  the  pollutions  arose  from  a  state 
of  irritation. 

All  his  organs  were  almost  equally  debilitated ;  and  all  his  functions  were 
badly  performed,  and  with  difficulty  •  his  sleep  was  broken  and  unrefreshing  ; 
his  temper  dull  and  irritable.  The  least  serious  occupation  gave  him  head- 
ache, and  a  desire  for  change  j  slight  exercise  induced  fatigue  ',  his  eyes 
were  very  weak  and  injected. 

On  the  22d  of  February,  1836,  the  patient  injected  a  solution  of  nitrate  of 
silver  (a  quarter  of  a  grain  to  the  ounce)  into  the  urethra.  About  half  the 
injection  entered  the  bladder,  and  remained  there  for  two  hours.  He  passed 
a  bad  night,  with  acute  pain,  and  had  a  pollution.  On  the  25th,  he  used 
another  injection,  stronger  than  the  first;  the  same  phenomena  followed. 
On  the  2d  of  March,  he  had  another  pollution.  On  the  6th,  his  urine  was 
thick,  fetid,  sanguinolent,  throwing  down  an  abundant  deposit  and  giving 
acute  pain  during  its  discharge.  Thirty  leeches  were  ordered  to  the  hypo- 
gastrium,  to  be  followed  by  a  hot  bath  and  emollient  cataplasms.  The 
symptoms  diminished  under  this  treatment.  On  the  24th  of  March,  another 
pollution  occurred,  and  from  this  date,  they  took  place  as  often  as  before ; 
complete  impotence  was  established.  In  this  condition,  the  patient  came  to 
consult  me  at  the  age  of  twenty-three.  His  urine  contained  a  white  deposit, 
which  led  me  to  suspect  that  he  had  diurnal  pollutions.  In  the  beginning 
of  July,  1836,  I  applied  the  nitrate  of  silver  from  the  neck  of  the  bladder  as 
far  as  the  bulb  of  the  urethra.  The  usual  phenomena  occurred.  A  fortnight 
afterwards,  all  the  inflammation  had  disappeared,  and  re-establishment  had 
commenced.     Six  months  afterwards,  I  received  the  following  note  from  M. 

S .     "  For  five  months  my  nocturnal  pollutions  have  ceased — at  least,  I 

have  only  had  one  every  ten  days  or  fortnight,  which  appears  inevitable, 
from  my  continued  continence.  My  urine  is  perfectly  transparent ;  my  tem- 
per is  improved,  and  I  study  with  pleasure,  and  without  fatigue.  My  erec- 
tions have  become  frequent  and  long  continued,  which  I  fancy  is  the  best 
proof  of  an  absolute  and  permanent  cure."  By  the  use  of  sexual  intercourse 
the  patient's  health  continued  to  improve  for  two  years,  during  which  time 
I  saw  him  frequently. 

This  patient  told  me  that  he  had  not  practised  masturbation  more 
frequently  than  his  companions,  but  he  had  commenced  long  before 
puberty,  and  his  constitution  was  naturally  weak.  He  also  asserted 
that  he  had  been  moderate  in  his  first  intercourse  with  the  other  sex, 


I 


VENEEEAL    EXCESSES.  175 

but  his  organs  had  been  previously  weakened  by  premature  abuse. 
These  circumstances  account  for  the  disastrous  effects  produced  by 
so  few  connections,  so  soon  left  off. 

A  hard  bed,  cold  bathing,  and  prolonged  exercise,  produced  bad 
effects  on  this  patient,  which  he  explained  correctly  by  referring  the 
symptoms  he  experienced  to  a  state  of  irritation  of  the  organs  in- 
stead of  one  of  atony. 

Tlie  mode  in  which  the  inflammation  extended  from  the  mucous 
membrane  of  the  urethra  to  the  spermatic  organs  is  very  evident  in 
this  case  ;  the  painful  spasm  which  was  present  in  the  neighborhood 
of  the  prostate,  the  habitual  irritability  of  the  urethra  and  vas  deferens, 
and  the  swelling  of  the  epididymis,  show  clearly  that  the  pollutions 
were  maintained  by  a  state  of  irritation.  It  is  remarkable,  that  injec- 
tions with  solution  of  nitrate  of  silver  should  have  caused  so  much 
pain,  and  produced  cystitis  without  any  permanent  benefit,  whilst  the 
nitrate,  applied  in  substance  to  the  disordered  tissues,  completely 
changed  their  action,  without  producing  any  untoward  results. 

The  cases  I  have  related  show  at  once  how  far  masturbation  may 
weaken  the  most  active  genital  organs,  at  the  period  of  their  greatest 
energy,  and  the  necessity  of  taking  into  consideration  the  actual 
condition  of  the  parts,  in  order  to  appreciate  the  effects  of  sexual 
intercourse. 

I  have  so  far  shown  that  blennorrhagia  and  masturbation  mav  leave 
a  degree  of  irritation  in  the  spermatic  organs,  or  perhaps,  a  peculiar 
susceptibility  easily  increased  by  coitus.  Hence  it  happens,  that  the 
virile  power  differs  much,  not  only  in  different  individuals,  but  in 
the  same  individuals  at  different  periods. 

Independently  of  the  changes  which  may  occur  before  the  act,  the 
organs  may  be  temporarily  exposed  to  others  just  as  hurtful.  And  I 
now  proceed  to  point  out,  by  two  or  three  cases,  the  chief  circum- 
stances which  may  thus  render  coitus  injurious. 


CASE  XLII. 

Masturbation —  Venereal  excesses — Prolonged  liorse  exercise — Blennorrliagia 
— Nocturnal  and  diurnal  polhuions — Two  caiiterizations — Recovery — 
Premature  excesses — Relapse — Cure  hy  another  cauterization. 

M,  T ,  of  robust  constitution,  and  bilio-sanguine  temperament,  con- 
tracted the  habit  of  masturbation  at  school.  At  the  age  of  fifteen,  he  cor- 
rected himself,  but  committed  venereal  excesses.  Still  bis  health  did  not 
undergo  any  notable  change  until  some  time  after,  when  he  was  obliged  to 
pass  the  greater  part  of  the  day,  and  often  part  of  the  night,  on  horseback. 
After  several  months  of  this  kind  of  life,  he  felt  weight  and  heat  in  the 
perineum,  with  pulsation  and  darting  pain  at  the  margin  of  the  anus. 
Hasmorrhoids  appeared,  and  his  sexual  feelings  diminished  by  degrees,  and 
at  length  entirely  left  him.  He  detested  the  sex ;  and  became  morose, 
taciturn,  and  irritable;  all  his  functions  were  disordered;  he  felt  cast  down. 


176  CAUSES    OF    SPEKMATOEEHCEA. 

careless,  physically  as  well  as  morally  depressed,  and  sought  solitude.  At 
length  he  commenced  the  study  of  medicine. 

A  professor,  whom  he  at  first  consulted,  believed  him  afflicted  with  gas- 
tritis, afterwards,  with  chronic  enteritis ;  still  later,  he  thought  him  hypo- 
chondriacal. In  this  condition,  at  the  age  of  twenty-five,  he  consulted  me. 
His  symptoms  were  much  the  same  as  those  I  have  related  in  so  many 
other  cases;  but  he  had,  in  addition,  a  constant  urethral  discharge. 

I  performed  two  cauterizations  for  this  patient,  sis  months  intervening 
between  them.  The  urethral  discharge  and  diurnal  pollutions  disappeared 
completely ;  and  his  nocturnal  pollutions  became  much  rarer ;  he  regained 
his  embonpoint,  and  his  former  strength  and  activity. 

Unfortunately  M.  T yielded    with  little    discretion  to  the  venereal 

desires,  which  resumed  their  empire  over  him.  A  relapse  resulted,  requiring 
another  cauterization,  which  produced  the  same  66*6013  as  the  former  ones  ; 
although  more  slowly.  His  health  was  afterwards  undisturbed  by  any  simi- 
lar accidents. 

The  masturbation  and  venereal  excesses  which,  in  this  case,  pre- 
ceded the  long  continued  horse  exercise,  must  be  taken  into  ac- 
count ;  they  certainly  predisposed  to  the  occurrence  of  blennorrhagia 
and  nocturnal  and  diurnal  pollutions. 

The  mode  of  action  of  horse  exercise  on  the  genital  organs  is  so 
evident,  as  not  to  require  explanation.  The  fact  is  worthy  of  notice, 
because  it  explains  the  advantages  or  inconveniences  of  this  exercise 
in  cases  of  spermatorrhoea,  according  as  they  arise  from  atony  or 
phlogosis  of  the  spermatic  organs. 

The  excitement  produced  by  horse  exercise  must  also  be  noticed 
as  a  circumstance  which  may  deceive  the  patient.  The  signs  of 
virility  which  it  excites  are  too  often  taken  for  natural  desires.  Even 
when  these  natural  desires  exist  at  the  same  time,  they  should  not 
be  satisfied  while  the  organs  are  in  a  state  of  irritation  and  fatigue 
from  riding,  because  the  act  itself  tends  to  produce  the  same  effects. 
Thus,  the  union  of  the  two  circumstances  may  produce  more  or  less 
severe  urethritis  and  its  usual  results.  In  the  foregoing  case,  as  in 
many  others,  I  have  seen  irritation  of  the  urethra  accompanying 
the  same  state  in  the  spermatic  organs  ;  this  is  a  very  common  co- 
incidence, and  one  very  easily  explained. 

The  relapse  this  patient  suffered  is  worthy  of  notice  on  account  of 
the  difficulties  which  a  convalescence  from  spermatorrhoea  presents. 
Scarcely  has  the  cure  begun  to  progress,  than  the  semen  is  retained 
longer  in  its  reservoirs ;  it  is  consequently  better  formed,  the  more 
fluid  part  being  absorbed  ;  hence  frequent,  energetic,  and  prolonged 
erections  are  excited.  A  time  may  arrive  when  these  will  become 
weakening  and  hurtful ;  the  testicles  continue  to  secrete,  and  the 
seminal  vesicles  have  only  a  certain  capacity ;  evacuations  must, 
therefore,  take  place ;  if  normal  ones  be  prevented,  they  will  occur 
abnormally,  and  the  pollutions  we  are  endeavoring  to  cure  will  re- 
appear.    Hence  moderate  exercise  of  the  organs  is  the  best  tonic  in 


VENEREAL    EXCESSES.  177 

this  Stage  of  the  case.  A  return  to  the  exercise  of  their  functions  is, 
therefore,  beneficial — indeed,  indispensable.  It  is  difficult  for  the 
practitioner  to  point  out  the  exact  moment  -when  such  return  should 
take  place,  and  for  the  patient  to  prevent  himself  from  overstepping 
the  bounds  of  the  most  importunate  necessity.  Unfortunately  the 
same  thing  occurs  in  these  cases,  that  we  see  daily  after  other  dis- 
eases— gastritis  for  instance;  when  a  little  food  is  allowed,  an  excess 
would  recall  all  the  irritation  of  the  stomach  ;  but  the  patient  often 
consults  his  appetite  more  than  his  power  of  digestion,  and  hence 
disorder  sometimes  arises  more  severe  than  the  first.  In  such  cases, 
however,  the  meals  may  be  watched,  the  food  chosen,  and  the  por- 
tions doled  out.  In  the  cases  under  consideration  such  watching  is 
impossible. 

CASE  XLIII. 

Lymphatic  temperament  —  Early  and  long  continued  masturhation  — 
Horse  exercise  —  Infrequent  coitus — Urethritis — Repeated  attacks  of 
inflcimmation  in  the  testicles — Frequent  discharge  of  urine — Pollutions 
during  defecation — Imperfect  ejaculation — Two  cauterizations  followed  hy 
perfect  recovery. 

Berthelot,  aet.  twenty-three,  of  lymphatic  temperament,  the  son  of  robust 
peasants,  enjoyed  perfect  health  during  his  infancy.  Between  the  ages  of 
ten  and  fourteen  he  practised  masturbation  frequently  with  the  other  chil- 
dren of  the  neighborhood,  although  he  experienced  little  sensation,  and  did 
not  pass  any  semen.  At  a  later  period,  he  addicted  himself  to  the  vice  as 
often  as  two  or  three  times  a  day.  Still  his  health  underwent  no  alteration. 
At  the  age  of  twenty-one,  he  entered  a  cavalry  regiment,  and  soon  after- 
wards had  cholera,  on  recovering  from  which  he  was  sent  to  his  native 
village  for  change.  He  hunted  much  at  this  time,  and  was  constantly  on 
horseback.  About  three  months  afterwards,  he  had  sexual  intercourse 
once  or  twice  a  day,  and  on  the  fifth  day  he  experienced  very  acute  pain 
in  the  urethra  during  the  passage  of  urine,  but  no  discharge  occurred.  He 
resumed  his  habitual  horse  exercise,  but  abstained  from  the  use  of  alcoholic 
drinks.  About  two  months  later,  B observed  that  he  passed  a  con- 
siderable quantity  of  semen  while  at  stool,  even  although  his  bowels  were 
not  constipated;  and  at  the  same  time  his  calls  to  urinate  became  more 
frequent  and  more  sudden,  so  that  he  passed  water  eight  or  ten  times  a  day, 
and  four  or  five  times  in  the  night.  Soon  afterwards,  after  a  long  ride,  he 
felt  pain  in  the  course  of  the  left  spermatic  cord,  which  soon  extended  to 
the  epididymis  and  testicle  of  the  corresponding  side.  Orchitis  was  esta- 
blished, but  yielded  to  the  usual  treatment,  leaving,  however,  a  chronic 
enlargement  of  the  epididymis.  Afterwards  the  patient  wore  a  suspensory 
bandage,  rode  on  horseback  again,  and  again  practised  masturbation.  He 
now,  for  the  first  time,  experienced  an  extraordinary  change  in  ejaculation. 
Very  little  semen  was  passed  by  the  urethra,  although  he  felt  internally  a 
sensation  which  announced  abundant  discharge.  The  greater  part  of  the 
emission  remained  in  the  urethra,  and  was  discharged  after  the  subsidence 
of  the  erection ;  even  then  the  patient  was  obliged  to  assist  its  escape,  by 
making  pressure  on  the  urethra.  This  occurred  even  during  nocturnal 
pollutions.     The  diurnal  discharges  during   defecation,  and  the  frequent 


178  CAUSES    OF    SPEEMATORRHCEA. 

desire  to  micturate  continued  ;  the  patient's  health  became  again  disordered, 
and  when  he  returned  to  his  regiment,  he  was  just  as  weak  and  thin  as  when 
recovering  from  the  effects  of  the  cholera. 

After  a  few  days'  active  service,  swelling  again  attacked  the  left  testicle : 
this  was  relieved  by  rest  and  emollients,  but  frequently  returned  again,  after 
slight  horse  exercise.  Acute  inflammation  also  attacked  the  right  spermatic 
cord,  epididymis,  and  testicle.  The  inflammation  was  dispersed  by  leeches, 
but  enlargement  of  the  cord  and  epididymis  remained.  Some  time  after,  the 
patient  complained  of  pain  in  his  chest,  sense  of  suffocation,  and  frequent 
attacks  of  digestive  disorder,  and  on  the  6th  of  August,  1886,  he  was  ad- 
mitted into  the  hospital  St.  Eloi,  under  the  care  of  Professor  Serre,  in  much 
the  same  condition  that  we  have  so  frequently  described. 

M.  Serre  cauterized  the  prostatic  portion  of  the  urethra,  after  which,  the 
patient's  efforts  during  defecation,  together  with  the  quantity  of  semen 
passed  at  stool,  diminished.  Micturition  became  less  frequent,  and  his  diges- 
tion and  moral  condition  improved.  In  this  state  I  saw  him  a  month  after 
the  cauterization  :  hoping  that  the  amendment  would  continue  to  progress,  I 
merely  prescribed  cold  ascending  douches  every  second  day.  Some  time 
after,  I  found  a  slight  diiEculty  in  passing  a  catheter  into  the  bladder.  The 
instrument  was  caught  near  the  neck  of  the  bladder  by  a  band,  which  caused 
a  kind  of  starting  upwards  of  its  point. 

In  any  other  part  of  the  canal  I  should  not  have  considered  this  obstacle 
worthy  of  notice,  but  its  seat  being  near  the  orifice  of  the  ejaculatory  ducts, 
I  questioned  the  patient  further.  From  what  I  then  learnt,  I  was  induced 
to  leave  an  instrument  in  the  urethra  for  an  hour,  and  to  repeat  this  once 
a  week.  The  ascending  douches  seemed  to  give  tone  to  the  rectum,  and 
the  introduction  of  the  catheter  freedom  to  the  urethra.  The  seminal  dis- 
charges diminished,  and  remarkable  improvement  in  all  the  functions  took 
place.  On  the  15th  of  October,  however,  a  pollution  occurred  during  defe- 
cation, and  was  repeated  on  the  19th.  At  the  same  time,  the  desire  of 
micturition  became  more  frequent.  On  the  21st  of  October,  therefore,  I 
determined  on  again  performing  cauterization  of  the  prostate,  applying  the 
caustic  especially  to  the  membranous  portion  of  the  urethra  in  front  of  the 
orifice  of  the  ejaculatory  ducts.  This  second  cauterization  perfected  the 
benefit  begun  by  the  first.  Defecation  was  performed  easily,  and  the  pol- 
lutions accompanying  it  ceased,  the  urine  became  quite  transparent,  and  was 
passed  at  normal  intervals  in  a  full  stream,  and  without  pain.  A  few  abun- 
dant nocturnal  emissions  occurred  at  intervals  of  ten  and  fifteen  days,  but 
they  were  always  preceded  by  erotic  dreams,  and  accompanied  with  lively 
sensations,  the  seminal  emissions  taking  place  very  freely  and  entirely.    And 

on  the  6th  of  December,  B left  the  hospital,  having  been  quite  well  for 

more  than  a  month.  I  advised  him,  however,  to  exchange  from  a  cavalry 
to  an  infantry  regiment. 

Berthelot  was  of  a  very  lymphatic  temperament,  and  he  had  con- 
tracted habits  of  abuse  four  years  before  puberty.  These  circum- 
stances must  have  had  their  influence  in  determining  the  effects 
produced  on  the  spermatic  organs.  But  the  immediate  cause  of  the 
disease  is  very  evident.  Coitus  was  only  repeated  a  few  times,  but 
whole  days  were  passed  on  horseback.  Riding  exercise  aggravated 
the  disorder,  and  produced  relapses.     To  its  effects  on  the  perineum 


VENEREAL    EXCESSES.  179 

the   urethritis,  and  the  repeated  attacks  of  orchitis  must  be  attri- 
buted. 

It  was  not  by  exposing  the  testicles  to  friction,  as  may  at  first 
sight  be  supposed,  that  the  horse  exercise  induced  orchitis ;  the  in- 
flammation commenced  in  the  vas  deferens,  extended  to  the  epi- 
didymis, and  thence  to  the  testicle.  The  action  of  the  saddle  on  the 
perineum,  therefore,  increased  the  urethral  inflammation,  and  favored 
its  extension  to  the  neighboring  mucous  membrane.  The  irritation 
extended,  not  only  to  the  testicles,  but  towards  the  kidneys.  The 
seminal  vesicles  were  then  in  the  same  condition  as  the  bladder,  and 
presented  the  same  phenomena — their  situation  between  the  ejacu- 
latory  ducts  and  the  testicles  being  the  same  as  that  of  the  bladder 
between  the  urethra  and  the  kidneys.  What  passed  in  the  bladder 
was  only  the  exaggeration  of  what  took  place  in  the  seminal  vesicles. 
The  influence  of  this  phlogosis  even  extended  to  the  sphincters  of 
the  anus,  since  the  expulsion  of  relaxed  motions  required  consider- 
able efforts. 

I  have  already  related  (page  148)  a  case  of  nocturnal  pollutions, 
in  which  no  external  evacuation  took  place,  all  the  semen  passing  into 
the  bladder,  and  being  afterwards  expelled  with  the  urine.  This 
occurred  in  consequence  of  compression  having  been  made  on  the 
perineum  to  prevent  ejaculation.  I  have  seen  another  case,  in  which 
the  same  thing  happened  after  blennorrhagia,  and  Berthelot  presented 
something  similar,  but  in  him  all  the  circumstances  were  still  more 
marked.  There  could  be  no  doubt  as  to  the  observations  he  made 
during  masturbation.  He  always  experienced  the  same  voluptuous 
sensations,  which  were  accompanied  by  a  kind  of  internal  perturba- 
tion, and  he  observed  the  discharge  at  the  time  of  only  two  or  three 
drops  of  semen.  After  nocturnal  pollutions,  he  constantly  found  on 
waking,  a  considerable  quantity  of  semen  in  the  urethral  canal. 
These  phenomena  were  easily  observed,  and  he  did  so  many  times. 

I  have  frequently  seen  the  same  effects  take  place  in  very  long  and 
tight  strictures  of  the  urethra;  but  in  Berthelot,  a  No.  12  catheter 
passed  easily  into  the  bladder.  The  orifice  of  the  ejaculatory  ducts 
must,  therefore,  have  been  altered  by  some  cicatrix  in  the  neighbor- 
hood of  the  verumontanum.  The  presence  of  this  was  made  evident 
by  the  slight  deviation  of  the  point  of  the  catheter  before  entering 
the  bladder.  The  presence  of  such  a  cicatrix,  in  this  situation,  in- 
dicates clearly  enough  that  inflammation  has  been  active  near  the 
orifice  of  the  ejaculatory  ducts  ;  hence  it  may  be  supposed,  that  the 
effects  of  horse  exercise  on  the  perineum  must  have  contributed  to 
its  development,  and  to  the  extension  of  the  inflammation  so  fre- 
quently to  the  testicles. 

I  have  shown  in  another  place  (page  100)  that  horse  exercise  may 
contribute  to  produce  diurnal  pollutions  by  its  action  on  the  margin 
of  the  anus  causing  obstinate  constipation  ;  and  I  have  also  pointed 
out  that  it  may  have  very  injurious  effects  about  the  period  of  puberty 
(page  151)  by  inducing  accidental  emissions,  or  leading  to  bad  habits. 
These  cases,  with  those  I  have  just  related,  show  that  horse  exercise 


180  CAUSES    OF    SPEEMATOEEHCEA. 

may  cause  hurtful  excitement  of  the  genital  organs ;  first,  by  inducing 
obstinate  constipation  ;  secondly,  by  producing  abnormal  excitement, 
•which  may  lead  to  abuse  ;  thirdly,  by  rendering  coitus  irritating  ; 
fourthly,  by  increasing  irritation  previously  set  up  by  recent  excesses. 

I  do  not  pretend  to  assert  that  horse  exercise  often  produces  such 
unfortunate  results,  but  it  is  important  to  know  how  and  under  what 
circumstances  they  may  be  produced — in  a  word,  what  influence 
horse  exercise  may  have  in  causing  spermatorrhoea.  All  that  I  have 
now  said  of  course  applies  to  the  other  exercises  which  act  on  the 
genital  organs,  and  whose  action,  though  less  energetic,  may  be  more 
prolonged. 

Every  one  knows  the  effect  produced  by  long  journeys,  even  in  the 
easiest  carriages.  The  increase  of  temperature  which  all  the  parts 
that  bear  the  weight  of  the  body  experience,  and  the  continual  shaking 
to  which  they  are  submitted,  excite  importunate  erections,  which  are 
commonly  followed  by  fatigue  and  irritation.  The  increased  flow 
of  blood  often  suffices  to  reproduce  urethral  discharges  which  had 
ceased  for  some  time.  I  have  been  consulted  many  times  in  cases 
of  this  nature — indeed,  there  are  some  persons  who  cannot  pass  a 
few  days  in  travelling,  without  having  a  slight  gleet.  These  effects 
are  not  equally  severe  in  all,  but  all  experience  an  increased  excite- 
ment, which  it  is  necessary  to  be  guarded  against,  because  it  excites 
desires  which  may  be  easily  mistaken  for  real  necessities.  There  is 
more  importance  in  these  apparently  trivial  circumstances,  than  is 
generally  supposed.  Hence  I  have  called  attention  to  them  en 
passant. 

I  have  already  shown,  that  the  action  of  alcoholic  liquors  on  the 
genital  organs  may  induce  spermatorrhoea  (see  case  twenty-one).  I 
now  proceed  to  show  the  influence  they  exert  on  the  venereal  act. 

CASE  XLIV. 

Lymphatico- sanguineous  temperament — Coitus  lohen  nearly  intoxicated,  at 
the  age  of  tioenty-tico — Blennorliagia — Pollutions  during  defecation — 
Disturbance  during  ejaculation — Band  in  the  membranous  portion  of  the 
wethra —  Cauterization —  Cure. 

Gros,  a  soldier  in  the  57th  regiment,  set,  twenty-five,  of  lymphatico-san- 
guineous  temperament,  always  enjoyed  perfect  health,  until,  in  1833,  after  a 
debauch  he  had  sexual  intercourse.  He  only  remembers  that  the  coitus  was 
very  long  and  slightly  painful.  Immediately  afterwards,  he  felt  pain  in  the 
pelvis,  which  soon  extended  to  the  testicles,  and  never  entirely  left  him 
afterwards.  The  following  day  a  clear  urethral  discharge  came  on,  which 
soon,  however,  became  greenish.  This  varied  much  in  its  after  appearances, 
and  sometimes  passed  off  entirely  for  a  day  or  two.  This  blennorhagia  drew 
the  patient's  attention  to  a  discharge  from  the  urethra  during  defecation. 
At  first,  a  few  drops  of  a  viscid  fluid  like  white  of  egg  were  discharged,  and 
these  were  followed  by  an  abundant  evacuation  of  semen.  This  evacuation 
always  took  place,  varying  in  quantity  according  to  the  efforts  required 
during  defecation. 


VENEREAL    EXCESSES.  181 

From  this  time  the  patient  practised  masturbation,  and  at  the  moment  of 
ejaculation,  he  felt  a  kind  of  commotion  in  the  urethfd,  and  observed  that 
nothing  was  passed  externally.  After  the  erection  had  subsided,  the  semen 
escaped  gradually.  This  he  always  noticed,  though  sometimes  the  semen 
remained  in  the  canal  for  half  an  hour.  When  nocturnal  pollutions  occurred, 
the  greater  pai't  of  the  emission  remained  in  the  urethra  until  the  patient 
awoke. 

During  eighteen  months,  Gros  underwent  no  medical  treatment;  after- 
wards he  took  emollients,  preparations  of  iron,  mercurial  pills,  large  doses 
of  copaiba  and  cubebs,  and  of  Chopart's  mixture;  injections  of  all  kinds 
were  also  employed  without  benefit.  About  the  end  of  August,  1836,  he 
came  to  consult  me.  He  had  frequently  had  sexual  intercourse  without 
communicating  any  disease  to  the  female.  The  urethral  discharge,  and 
the  pollutions  during  defecation,  continued  to  the  same  degree;  the  urine 
was  passed  very  frequently,  and  was  generally  rendered  opaque  by  a  thick 
cloud.  Still,  however,  the  patient's  functions  were  performed  pretty  regu- 
larly, and  he  had  not  lost  flesh ;  but  his  muscles  were  soft  and  flabby,  his 
thoughts  gloomy,  and  his  voice  weak  and  husky.  Constant  pain  had  an- 
noyed him  for  two  years  in  the  joints,  groins,  and  along  the  spermatic  cords 
to  the  testicles.  His  eyes  were  intolerant  of  light,  and  constantly  afl'ected 
by  a  prickling  pain. 

The  introduction  of  a  catheter  gave  acute  pain;  the  instrument  was  arrested 
for  a  moment  in  front  of  the  neck  of  the  bladder,  by  a  little  band,  which 
tilted  up  its  points. 

On  the  7th  of  October,  I  cauterized  the  membranous  portion  of  the  canal ; 
acute  and  long-continued  pain  followed,  and  the  urine  was  bloody  and  abun- 
dant. This  inflammation  had  entirely  disappeared  at  the  expiration  of  three 
weeks,  when  the  discharge  rapidly  diminished  and  soon  disappeared.  The 
eff'orts  at  stool,  and  the  seminal  discharges  which  accompanied  them,  had 
ceased  much  earlier,  and  the  pains  in  the  groins,  spermatic  cords,  and  tes- 
ticles, as  well  as  the  sensations  the  patient  experienced  in  his  eyes  were 
relieved. 

When  Gros  left  the  hospital,  he  was  free  from  all  the  appreciable  symp- 
toms which  he  had  on  entering;  as  regarded  ejaculation,  of  course  he  was 
unable  to  give  any  information,  but  he  promised  to  let  me  know  if  he  found 
the  discharge  arrested  in  the  canal  as  before,  and  from  that  time  I  have  heard 
nothing  from  him. 

This  patient  was  in  the  hospital  at  the  same  time  as  the  subject 
of  the  preceding  case,  and  I  placed  them  in  adjoining  beds,  in  order 
the  better  to  contrast  their  symptoms.  Both  were  of  the  same  age, 
and  both  experienced  the  same  pollutions,  and  the  same  difficulty  of 
ejaculation  after  an  attack  of  non-contagious  urethritis.  The  point 
of  the  catheter  communicated  the  same  sensation  of  obstruction  in 
both,  and  the  same  treatment  cured  them  both. 

I  need  not  at  present  recur  to  what  I  have  stated  respecting  a 
cicatrix  situated  in  front  of  the  orifice  of  the  ejaculatory  ducts.  The 
most  simple  and  direct  means  by  which  to  obviate  its  effects  is  an 
active  cauterization  in  front  of  the  verumontanum.  On  this  account, 
in  these  two  patients  I  more  particularly  cauterized  the  membranous 
portion  of  the  urethra. 
12 


182  CAUSES    OF    SPEEMATOERH(EA. 

In  the  case  of  Gros,  a  single  connection  gave  rise  to  all  the  acci- 
dents; therefore,  it  can  scarcely  be  said  that  he  committed  excesses  ; 
but  the  act  was  not  brought  about  by  a  natural  necessity ;  it  was 
accomplished  in  a  laborious  manner  ;  under  circumstances  very  likely 
to  prolong  its  duration,  and  whilst  the  mucous  membrane  of  the 
genito-urinary  organs  was  exposed  to  considerable  over-excitement. 
The  act  was  therefore  inopportune,  and  as  such,  it  produced  the 
effects  of  an  excess.  The  urethritis  following  it  seems  to  have  been 
produced  by  the  excessive  duration  of  the  act,  and  by  the  excitement 
of  the  organs  by  alcoholic  stimuli  before  they  were  submitted  to 
this  fatigue.  The  color  of  the  discharge  showed  that  it  was  not 
spermatic.  It  seemed  to  be  an  ordinary  gleet,  arising  from  the  same 
cause  as  the  chronic  vesical  catarrh  and  the  involuntary  seminal  dis- 
charo-es. 


CASE  XLV. 

Coitus  in  a  state  apirroachivg  inehriety — Gleet  increased  hy  a  Journry — 
Diurnal  pollutions —  Cauterization,  icith  rapid  improvement — Relapse 
from  premature  fati(jue  of  the  onjans — Cure  hy  means  of  antiphlogistics 
and  rest. 

M.  R ,  a  student  of  medicine,  a  native  of  the  tropics,  and  of  a  very 

nervous  temperament,  addicted  himself  to  masturbation  about  the  period  of 
puberty,  and  later  to  venereal  excesses  and  the  use  of  alcoholic  liquors. 
His  health  became  disordered,  but  by  a  regular  life  and  exercise  he  strength- 
ened his  constitution,  and  for  several  yeai-s  his  health  was  excellent. 

In  1836,  after  a  debauch,  when  nearly  intoxicated,  he  repeated  coitus 
twice  during  the  night,  each  time  with  unusual  difficulty.  On  the  fourth 
day  he  experienced  pain  in  the  canal,  and  scalding  during  the  passage  of 
urine.  A.  slight  mucous  discharge  soon  appeared,  and  became  more  abun- 
dant by  degrees.  Baths  and  emollients  diminished  the  irritation;  but  it  in- 
creased afresh  during  a  long  journey,  which  the  patient  was  obliged  to  take. 
After  his  return,  he  often  applied  leeches,  and  took  copaiba,  without  being 
able  to  lessen  the  discharge.  Every  morning  and  evening  and  during  the 
day,  the  point  of  the  glans  was  moistened  by  a  drop  of  viscid  fluid.  This 
circumstance  would  not  have  attracted  his  attention  if  he  had  not  at  the  same 
time  noticed  a  remarkable  diminution  in  his  virile  powers.  Ejaculation  be- 
came very  rapid;  the  erections  remained  incomplete;  and  several  times  the 
act  was  impossible.  The  patient  had  pain  in  the  spermatic  cords  and  testicles  ; 
a  sense  of  weight  in  the  perineum,  and  at  the  margin  of  the  anus ;  both  his 
limbs  and  his  intellect  grevv'  weak.  Absorbed,  in  spite  of  himself,  in  con- 
sideration of  his  condition,  he  was  unable  to  pay  attention  to  anything  else. 
He  lost  his  memory,  was  constantly  abstracted,  and  incapable  of  applying 
himself  in  any  intellectual  employment,  or  bodily  exercise.  This  mental  and 
physicalweakness,  together  with  the  disorder  of  all  his  functions,  had  increased 
rapidly,  when  the  patient  came  under  my  care.  It  was  not  difficult  to  dis- 
cover the  origin  of  his  disorder.  Each  stool  was  accompanied  by  more  or  less 
abundant  seminal  discharges,  and  the  patient's  urine  constantly  contained  a 
considerable  quantity  of  well  formed  semen,  full  of  granules  like  boiled  rice. 


I 


VENEREAL    EXCESSES.  183 

In  the  beginning  of  June,  1837,  I  cauterized  the  prostatic  portion  of  the 
urethra.  The  operation  produced  its  ordinary  immediate  effects.  As  soon 
as  the  inflammation  had  passed  off,  the  diurnal  pollutions  disappeared,  and 
energetic  erections  returned.  The  premature  use  of  coitus,  however,  added 
to  over  fatigue  during  very  hot  weather,  reproduced  the  irritation  in  the 
urethra,  together  with  the  diurnal  pollutions,  and  the  general  symptoms  that 
accompanied  them.  This  relapse  I  treated  with  leeches,  baths,  enemata, 
and  strict  repose,  which  simple  means  soon  brought  about  a  perfect  cure,  and 
rendered  a  second  cauterization  unnecessary,  although  the  patient  pressingly 
demanded  it. 

Under  other  circumstances  M.  R had  committed  considerable 

excesses  without  experiencing  any  ill  effects.  To  what,  then,  can 
we  attribute  the  occurrence  of  the  urethritis  and  the  diurnal  pollu- 
tions following  it,  but  to  the  effects  of  the  alcoholic  stimuli  ? 

The  last  part  of  this  case  shows  how  necessary  it  is  not  to  disturb 
the  effects  of  cauterization  by  any  circumstances  which  may  re-excite 
the  irritation.  It  would  be  dangerous  to  recur  to  the  same  treat- 
ment, when  irritation  is  again  set  up  a  few  days  after  cauterization 
by  the  influence  of  exciting  causes.  When  on  the  other  hand,  under 
such  circumstances,  antiphlogistics  are  employed,  and  rest  is^enjoined, 
the  symptoms  disappear  rapidly;  the  cure  is,  therefore,  only  retarded : 
a  second  cauterization  in  such  a  case  might  be  expected  to  produce 
much  disorder. 

These  effects  from  the  excessive  use  of  stimuli  are  by  no  means 
rare,  judging  from  the  number  of  cases  I  have  met  with ;  the  two 
related  are,  however,  sufficient  to  give  an  idea  of  the  general  circum- 
stances attending  such  cases;  I  shall,  therefore,  only  extract  the 
most  important  features  of  the  others  of  which  I  have  notes. 

None  of  my  patients  were  completely  intoxicated  at  the  moment 
of  coitus,  but  all  were  more  or  less  approaching  that  state.  Few 
repeated  the  act ;  and  some  even  were  unable  to  terminate  it.  In 
all  it  was  long,  laborious,  and  attended  with  little  pleasure ;  and 
the  inflammation  or  irritation  of  the  urethra  came  on  very  quickly. 
Urethral  discharge  did  not  invariably  arise :  when  it  did  occur,  it 
appeared  very  quickly.  The  pain  produced,  as  well  as  the  color  of 
the  discharge,  differed  much  in  different  individuals.  In  two  cases 
retention  of  urine  occurred  on  the  day  following,  and  in  another, 
prostatitis  was  set  up.  Several  patients  passed  dark-colored  and 
even  sanguinolent  urine  for  several  days. 

All  fermented  drinks  are  not  equally  hurtful,  and  according  to  my 
experience,  beer  produces  the  worst  eflfects,  especially  when  new. 

To  resume :  a  state  approaching  intoxication  may  be  hurtful  in 
two  ways ;  first,  by  diminishing  the  sensibility  of  the  nervous  system  : 
secondly,  by  favoring  the  occurrence  of  irritation  in  the  genito-uri- 
nary  mucous  membrane.  As  this  double  action  may  appear  contra- 
dictory, I  will  explain  it. 

During  complete  intoxication  coitus  is  impossible,  because  the 
functions  of  the  cerebro-spinal  system  are  suspended.     But  when 


184  CAUSES    OF    SPERMATOERHCEA. 

fermented  liquors  have  produced  effects  short  of  stupefaction,  when 
excitement  is  followed  by  a  commencintr  weakness,  with  a  disposition 
to  somnolency,  venereal  excitement  is  frequently  manifested,  on  the 
nature  of  which  it  is  very  easy  to  be  deceived,  because  in  this  state 
nothing  is  feared. 

Indifferent  erections  occur.  These  may  suffice  to  permit  the  com- 
mencement of  coitus,  but  the  sensibility  of  the  genital  organs  is 
blunted,  for  the  same  reason  that  all  other  sensations  are  vague  and 
dull.  The  pleasurable  feeling  may  be  sufficient  to  keep  up  the  erec- 
tion, but  does  not  suffice  to  produce  that  high  state  of  excitement 
which  is  necessary  for  the  acccomplishment  of  the  act.  This  diminu- 
tion of  sensibility  then,  renders  coitus  incomplete,  or  retards  its 
consummation,  sometimes  even  rendering  it  impossible.  It  becomes 
evident,  therefore,  that  such  ineffectual  efforts  must  favor  the  deve- 
lopment of  irritation  in  parts  which  are  at  the  same  time  in  a  state 
of  more  or  less  active  congestion. 

Again,  on  the  other  hand,  it  is  well  known  that  fermented  liquors 
irritate  the  genito-urinary  organs,  and  that  those  who  take  them  in 
excess  frequently  lose  their  virility.  It  is  well  known  too,  that 
drunkards  are  subject  to  chronic  catarrh  of  the  bladder,  to  engorge- 
ment of  the  prostate,  dysuria,  retention  of  urine,  and  chronic  gleet ; 
and  I  have  before  shown  that  wine  is  hurtful  to  patients  laboring 
under  spermatorrhoea  (see  case  21). 

Fermented  drinks,  then,  taken  in  excess,  produce  an  excitement  in 
the  genito-urinary  organs,  which  is  very  likely  to  run  into  a  state  of 
permanent  irritation,  at  the  same  time  that  they  disturb  the  intellect, 
blunt  all  sensations,  and  prolong  the  efforts  of  coitus  by  postponing 
the  convulsive  action  which  concludes  the  act.  Hence  it  occurs  that 
these  tissues,  already  irritated  by  the  direct  action  of  the  fermented 
liquors,  are  still  more  disordered  by  the  violent  and  prolonged  action 
of  such  unsuitable  efforts.  It  is  not  wonderful,  then,  that  coitus 
under  such  unfavorable  circumstances  should  often  produce  hurtful 
results. 

Characteristics  of  venereal  excesses. — The  immoderate  and  conse- 
quently injurious  use  of  a  thing,  useful  within  proper  limits,  consti- 
tutes an  excess.  We  must,  therefore,  consider  the  act  of  sexual 
intercourse  under  two  points  of  view,  in  order  fully  to  understand 
its  different  effects.  It  is  widely  different  from  all  abuses,  which  can 
never  be  of  service,  however  rarely  they  may  be  practised. 

But  to  what  extent  may  intercourse  be  regarded  as  moderate  and 
useful,  or  at  all  events  as  not  hurtful?  When  do  excesses  and  con- 
sequently danger  commence?  These  important  questions  have  never 
been  clearly  resolved.  In  such  a  consideration  each  consults  his  own 
experience,  and  arrives  at  a  different  conclusion.  The  power  and 
activity  of  the  organs  of  generation,  as  I  have  already  stated,  vary 
extremely  in  different  individuals,  and  even  in  the  same  individual  at 
slightly  distant  periods.  No  other  organs  in  the  economy  present 
so  great  a  variety  in  the  activity  of  their  functions.    It  is,  therefore, 


VENEREAL    EXCESSES.  185 

evident  that  any  statement  in  numbers  would  be  incorrect  as  regards 
the  majority  of  cases. 

The  tvants  of  the  genital  system  can  alone  furnish  data  applicable 
to  each  case.  But  the  appreciation  of  these  wants  is  not  so  easy  as 
might  be  supposed.  They  vary  with  the  individual,  with  the  age, 
and  a  host  of  other  circumstances,  the  combinations  of  which  are 
almost  infinite. 

The  genital  ivants  may  be  factitious  ;  a  violent  attachment  may,  in 
this  respect,  give  rise  to  great  illusions  ;  the  direct  irritation  brought 
on  by  Herpes  preputialis,  or  by  the  presence  of  ascarides  in  the  rec- 
tum, may  excite  morbid  erections  which  have  no  connection  with  the 
real  wants  of  the  system.  Irritation  of  the  cerebellum,  the  spinal  cord, 
or  the  nerves  supplying  the  genital  organs,  may  produce  the  same 
effects,  so  that  the  frequency  and  duration  of  the  erections  will  not 
always  show  the  amount  of  the  true  powers.  In  many  persons  the 
desires  are  greater  than  the  powers  of  fulfilment;  the  imagination  of 
such  is  constantly  occupied  by  erotic  ideas  whilst  their  physical  pow- 
ers are  very  little.  The  impulse  in  these  persons  is  purely  derived 
from  the  brain,  and  their  immoderate  desires  cannot,  therefore,  fur- 
nish a  measure  of  their  real  wants. 

On  the  oth-er  hand,  a  too  absolute  and  lengthened  continence  may 
end  by  throwing  the  genital  instinct  into  a  state  of  inertia,  which 
might  be  mistaken  for  impotence,  and  which  may  lead  to  it,  as  we 
shall  see  by  and  by. 

Excessive  spermatic  plethora  is  generally  accompanied  by  a  feel- 
ing of  uneasiness  and  anxiety,  with  general  discomfort,  headache,  lazi- 
ness, and  somnolency,  or  perhaps,  in  other  cases,  agitation,  sleep- 
lessness, impatience  in  temper,  inaptitude  for  intellectual  employ- 
ment, despondency,  love  of  solitude,  and  swelling  and  pain  of  the 
spermatic  cords  and  testicles.  These  symptoms  are  especially  seen 
about  the  age  of  puberty,  in  lads  who  have  escaped  falling  into  bad 
habits,  and  who  have  never  had  sexual  intercourse ;  they  are  not  rare 
in  persons  more  advanced  in  life,  who  have  been  suddenly  deprived 
of  intercourse  which  had  become  habitual  to  them.  It  is  remarkable 
that  many  of  the  same  symptoms  are  found  in  cases  of  spermatorrhoea. 
It  is  sufficiently  astonishing  to  find  such  opposite  causes  producing 
similar  results,  yet  we  see  the  same  thing  occur  daily  in  other  cases. 
For  instance,  too  large  or  too  often  repeated  bleeding  constantly  pro- 
duces vertigo,  dizziness,  noise  in  the  ears,  convulsions,  palpitation  of 
the  heart,  &c.,  although  these  symptoms  usually  depend  on  a  state  of 
plethora.  I  have  related  many  cases  in  which  extreme  weakness  was 
accompanied  by  symptoms  likely  enough  to  cause  a  dread  of  apo- 
plexy, cerebral  affections,  or  disease  of  the  heart. 

From  such  facts,  then,  we  may  conclude,  that  opposite  conditions 
of  the  economy  may  produce  phenomena  sufficiently  alike  for  skilful 
practitioners  to  be  mistaken  in  them  ;  and  we  must  not  be  astonished 
at  finding  that  a  too  long  continence  should  bring  on  phenomena 
similar  to  those  observed  after  too  often  repeated  seminal  discharges. 


186  CAUSES    OF    SPERMATOEEHCEA. 

It  is  difficult,  then,  to  judge  a  priori  of  the  real  wants  of  any  indi- 
vidual, because  the  frequency  and  duration  of  the  erections,  the 
activity  of  the  venereal  desires,  and  the  phenomena  observed  in  the 
dififerent  functions  of  the  economy,  may  prove  deceitful.  This  is  not 
the  case,  if  we  only  consider  the  effects  that  immediately  follow  the 
venereal  act.  It  is  then  always  easy  to  foresee  the  remote  conse- 
quences which  are  to  be  expected  from  more  frequent  sexual  indul- 
gence. The  following  signs  cannot  be  misunderstood,  and  are  appli- 
cable in  all  cases. 

When  coitus  is  followed  by  a  sense  of  happiness,  of  general  com- 
fort, and  of  increased  strength  ;  when  the  intellect  is  more  acute,  and 
the  body  more  active;  when  an  inclination  to  take  exercise,  or  to 
engage  in  intellectual  excitement  is  observed,  together  with  increased 
activity  of  the  genital  organs,  it  is  evident  that  an  imperious  want 
has  been  satisfied  within  the  limits  necessary  to  health.  The  happy 
influence  all  the  organs  experience  from  the  act  is  similar  to  that 
which  follows  the  accomplishment  of  every  other  function  necessary 
to  the  economy. 

When,  on  the  contrary,  coitus  is  followed  by  a  feeling  of  sadness, 
of  uneasiness,  fatigue,  or  satiety  ;  when  heaviness  of  the  head  and  a 
disposition  to  sleep  occur,  with  confusion  in  the  ideas  and  disinclina- 
tion for  exercise,  it  may  be  presumed  that  the  act  has  been  too  often 
repeated,  or  performed  under  unfavorable  circumstances  ;  and  erec- 
tions, however  energetic,  which  occur  soon  afterwards,  should  be 
considered  as  excited  by  the  commencement  of  irritation,  and  not  by 
the  return  of  the  want. 

It  is  only  when  coitus  is  followed  by  all  these  marks  of  debility, 
that  it  is  injurious  ;  indeed,  sadness,  ill-temper,  and  regret  are  never 
shown,  unless  the  act  be  too  often  or  unseasonably  repeated.  Such 
conditions,  therefore,  should  be  sufficient  to  show  that  there  has  been 
either  excess  or  unfitness — which  produce  the  same  effects. 

These  two  classes  of  phenomena,  however,  are  rarely  of  so  striking 
a  nature  as  I  have  just  supposed,  because  on  the  one  hand,  the  want 
is  seldom  very  imperious,  and  on  the  other,  the  excess  is  seldom  very 
great ;  but  at  the  same  time  there  are  few  who  have  not  experienced 
something  analogous  to  the  one  case  or  the  other.  Cases  intermediate 
between  these  extremes,  constitute  the  ordinary  course  of  life  ;  then 
coitus  is  followed  by  no  remarkable  phenomena,  and  hence  we  must 
conclude  that  in  the  majority  of  cases  it  is  far  from  exerting  the 
hurtful  influence  on  the  economy  that  has  been  attributed  to  it.  It  is 
true,  that  I  have  related  cases  in  which  coitus  seldom  repeated  was 
attended  by  the  most  unfortunate  results  ;  but  in  such  cases  the  pre- 
vious or  concomitant  circumstances  must  be  taken  into  consideration. 

The  causes  capable  of  rendering  coitus  hurtful  are  very  various 
and  frequent.  I  have  hitherto  only  considered  a  few  of  them.  I 
now  proceed  to  comment  on  others,  which  may  act  indirectly  in 
bringing  on  spermatorrhoea,  either  by  inducing  excesses  or  by  dis- 
ordering the  act  itself. 


VENEREAL    EXCESSES.  187 

Causes  of  Venereal  Excesses. — In  a  former  chapter  I  have 
pointed  out  the  pathological  causes  that  may  bring  on  accidental 
irritation  of  the  genital  organs  and  excite  abuse :  it  is  evident  that 
the  same  circumstances  may  equally  lead  to  venereal  excesses:  what 
I  have  already  said,  therefore,  applies  to  the  subject  specially  under 
our  consideration. 

Age. — The  sensibility  which  the  genital  organs  acquire  at  the  age 
of  puberty,  the  kind  of  habitual  orgasm  of  which  they  become  the 
seat,  the  confidence  in  strength  imparted  by  an  unusual  sense  of  vi- 
gor, together  with  the  want  of  experience,  may  cause  the  youth  to 
be  carried  away  by  the  violence  of  his  first  feelings.  But  generally 
from  our  social  state,  he  experiences  obstacles  sufficiently  powerful 
to  subdue  his  passions  more  or  less  completely.  This  would  be 
highly  advantageous,  if  the  desires  did  not  break  forth  at  a  later  pe- 
riod, in  a  manner  even  still  more  dangerous.  It  is  rarely,  then,  that 
the  youth  meets  with  circumstances  favorable  to  habitual  excesses 
capable  of  injuring  his  health.  I  have  met  with  few  such  examples 
at  this  early  age,  in  comparison  with  the  number  of  cases  of  mas- 
turbation. 

When,  however,  the  development  of  the  man  is  completed,  and  the 
law  sanctions  his  emancipation  from  authority,  he  enjoys  perfect 
freedom  in  his  actions,  or  he  marries  ;  and  then  it  is,  that  free  from 
all  restraint,  he  gives  license  to  his  previously  subdued  passions. 
But  if  sexual  intercourse  is  more  frequent  now  than  at  an}'^  other 
period,  the  virile  power  also  exists  in  greater  energy,  and  the  resist- 
ance to  the  causes  of  injury  is  more  active  :  if  the  excitement,  there- 
fore, arise  only  from  the  genital  organs,  there  will  be  no  greater  ex- 
cesses now  than  at  any  other  time,  because  the  real  wants  are 
greater. 

At  a  later  period  the  powers  diminish  by  degrees,  until  they  be- 
come extinguished  in  old  age,  but  the  desires  follow  the  same  course. 
Thus  then  the  energy  of  the  genital  organs,  at  the  period  of  the 
greatest  virility,  would  not  suffice  to  induce  excesses,  if  other  causes 
were  not  superadded  ;  and,  on  the  other  hand,  the  diminution  of  their 
power,  with  advancing  age,  would  not  render  coitus  more  dangerous, 
but  more  rare. 

Teynperament. — The  predominance  of  the  lymphatic  temperament 
renders  the  economy  little  capable  of  supporting  venereal  excesses, 
but  at  the  same  time,  this  temperament  predisposes  to  them  loss  than 
any  other.  All  other  circumstances  being  equal,  individuals,  in 
whom  the  lymphatic  temperament  is  very  marked,  are  less  excitable 
and  less  susceptible  of  being  carried  away  by  their  passions. 

The  sanguineous  temperament  seems  to  be  the  one  most  favorable 
to  activity  of  the  genital  organs  ;  but  at  the  same  time  this  tempera- 
ment supports  such  activity  better  than  any  other. 

In  persons  of  nervous  temperament  the  action  of  the  genital 
organs  is  apt  to  be  confounded  with  that  of  the  brain ;  of  which  I 
shall  speak  shortly. 


188  CAUSES    OF    SPERMATORRHEA. 

Neither  ace  nor  temperament,  then,  can  be  set  down  as  the  true 
cause  of  venereal  excesses,  and  of  the  disorders  to  which  they  give 
rise. 

Genital  Instinct. — The  organs  composing  the  reproductive  system 
may  be  divided  into  two  very  distinct  systems,  the  one  destined  for 
the  material  performance,  the  other  for  manifesting  the  impulses  and 
directing  the  actions  which  lead  to  it.  Proper  harmony  generally 
exists  between  these  two  systems  at  the  periods  of  evolution  and 
diminution  of  power  in  the  organs,  as  well  as  at  the  time  of  their 
greatest  power  and  activity  :  this  is  why  the  phenomena  having  refe- 
rence to  generation  have  been  generally  attributed  to  the  exclusive 
influence  of  the  sexual  organs,  such  influence  being  more  easily 
observed  than  that  of  the  encephalon.  I  have,  however,  shown  that 
tlie  genital  instinct  may  be  developed  long  before  the  epoch  of 
puberty  ;  I  now  proceed  to  show  that  the  two  systems  have  not  inva- 
riably an  equal  degree  of  development  or  activity,  and  to  point  out 
the  results  of  the  preponderance  of  one  system  or  the  other. 

Genital  Organs. — No  other  organs  present  such  considerable  difi'er- 
ences  either  in  development  or  power.  I  have  met  with  individuals 
who  early  addicted  themselves  to  unbridled  masturbation,  and  who 
afterwards  committed  great  venereal  excesses,  continued  even  to  the 
age  of  sixty,  without  notable  injury  to  their  health  ;  whilst  on  the 
other  hand,  I  have  seen  others,  who  experienced  very  serious  noc- 
turnal and  diurnal  pollutions,  as  a  consequence  of  very  slight  errors 
of  conduct. 

These  diff"erences  of  constitution  are  not  always  marked  by  charac- 
ters announcing  a  predominance  of  one  of  the  elements  which  con- 
stitute the  organs  ;  still  less  are  they  shown  by  the  development  of 
the  frame  or  the  muscular  sysrem.  Thus,  with  a  sanguineous,  a  ner- 
vous, or  a  lymphatic  temperament,  and  with  either  a  robust  or  a  de- 
licate constitution,  the  genital  organs  may  present  all  the  varieties 
of  size,  power,  or  activity. 

The  condition  which  predisposes  least  to  sexual  excesses  is  that 
in  which  development  of  the  genital  organs  predominates  over  that 
of  their  encephalic  organ.  I  have  met  with  young  men  of  extraor- 
dinary virile  powers,  who  were  only  impelled  by  their  physical  wants. 
They  experienced  frequent  and  importunate  erections,  but  their  ima- 
gination remained  unexcited.  They  practised  masturbation,  or  had 
recourse  to  sexual  intercourse,  to  free  themselves  from  uneasiness, 
and  thought  no  more  of  the  act  as  soon  as  this  uneasiness  had  ceased. 
Such  patients  have  always  consulted  me  for  syphilis  or  blennorrhagia. 
The  opposite  conditions  are  those  which  predispose  to  excess. 

Eiiceplialio  Organs. — I  do  not  pretend  to  give  an  opinion  here  on 
the  part  of  the  brain  which  receives  the  sensations  derived  from  the 
sexual  system.  It  is  enough  to  know  that  some  such  organ  exists, 
and  that  its  action  may  precede  that  of  the  genital  organs,  and  con- 
tinue after  it,  or  in  other  words,  that  this  action  of  the  brain  may  pre- 
dominate.    Such  predominance  of  the  genital  instinct  over  the  mate- 


VENEREAL    EXCESSES.  189 

rial  instruments,  is  in  general  shown  very  early.  The  chil'lren  we 
see  occupied  with  women,  five,  six,  or  even  ten  years,  before  puberty, 
almost  always  show,  during  the  rest  of  their  lives,  the  same  suscepti- 
bility for  all  that  may  produce  or  recall  erotic  ideas,  whether  such 
impressions  arise  from  the  genital  organs,  or  are  excited  by  the  senses. 
They  preserve  a  very  lively  and  enduring  remembrance  of  these  im- 
pressions ;  their  imagination  gloats  over  them,  and  considers  them  in 
a  hundred  different  ways  :  voluptuous  images  are  mingled  with  their 
most  serious  thoughts,  disturb  all  their  meditations,  and  are  present 
even  in  their  dreams.  They  covet  all  women  ;  but  their  virile  powers 
do  not  suffice  for  the  activity  of  their  desires.  Coitus  fatigues  and 
enervates  them  ;  they  are  aware  of  this,  but  are  drawn  into  excess  in 
spite  of  themselves,  and  as  often  as  they  are  physically  able.  Such 
persons  have  no  more  power  over  their  will  than  the  insane ;  when 
they  feel  worn  out  after  coitus,  they  make  the  best  resolutions,  which 
they  break  as  soon  as  they  are  able,  at  the  same  time  foreseeing  that 
they  will  experience  injurious  effects  from  such  infringement. 

When  desires  are  only  excited  by  spermatic  plethora,  they  are 
appeased  as  soon  as  the  want  is  satisfied,  and  only  return  when  the 
loss  is  repaired.  There  could,  therefore,  never  be  a  real  excess  in 
such  a  case,  if  other  causes  did  not  determine  the  more  frequent  repe- 
tition of  the  act.  Grave  excesses,  however,  are  almost  inevitable, 
when  the  desires  are  found  in  great  disproportion  to  the  real  wants  of 
the  system.  A  brilliant  and  active  imagination,  an  exquisite  sensi- 
bility, and  great  brilliancy  of  ideas  are  often  joined  to  this  predomi- 
nance of  the  sexual  instinct.  Individuals  imbued  with  the  spirit  of 
poetry,  whom  we  call  nervous,  frequently  attach  the  most  seductive 
colors  to  their  recollections,  and  embellish  them  with  imaginary 
charms  ;  but  their  devouring  passions  are  badly  supported  by  their 
weak  and  irritable  organs. 

Such  predominance  of  the  nervous  system  too,  renders  the  organs 
exposed  to  abuse  or  excess  more  impressionable ;  and  as  their  func- 
tions may  be  easily  perverted,  it  is  evident  that  such  individuals  are 
very  liable  to  the  occurrence  of  spermatorrhoea.  Other  impulses 
derived  from  the  faculties  of  the  mind,  may  also  induce  an  individual 
to  overstep  the  limits  of  his  true  necessities.  Of  these  I  shall  now 
speak. 

Vanity  is  perhaps  the  most  common  cause  of  venereal  excesses. 
Man  covets  the  esteem  of  his  race;  and  especially  that  of  woman, 
of  whom  he  is  the  natural  protector.  It  is  when  in  the  presence  of 
woman  that  he  is  proud  of  his  intellectual  and  physical  superiority, 
and  of  his  social  position  ;  but  it  is  his  virile  power  of  which  he  is 
especially  proud,  and  which  he  endeavors  to  prove — those  who  are 
the  least  strong  in  this  repect,  fear  the  most  to  allow  their  weakness 
to  appear.  Hence  excesses  arise,  which  are  not  caused  by  the  real 
necessities,  and  which  do  not  spring  from  a  violent  passion.  Young 
men  who  have  given  themselves  up  to  the  ardor  of  their  passions 
soon  after  their    marriage,   endeavor   to  sustain  the  excesses  with 


190  CAUSES    OF    SPERMATOREHCEA. 

which  they  commenced.  They  dread  causing  a  suspicion  of  cool- 
ness, or  of  infidelity,  though  they  very  soon  repent  their  first  impru- 
dence— their  irritated  organs  being  no  longer  in  the  physiological 
condition  which  at  first  permitted  them  to  support  excesses.  If  I 
may  judge  from  the  facts  I  have  learned  from  patients,  their  venereal 
excesses  have  been  caused  more  frequently  by  an  unfortunate  vanity 
than  by  an  ardent  attachment.  I  admit  all  that  an  exclusive  and 
blind  passion  concentrated  on  one  object  is  capable  of ;  but  this  does 
not  prevent  the  impulses  of  which  I  have  just  spoken  from  acting  at 
the  same  time  ;  it  must  even  lend  them  more  energy. 

Excitement  caused  by  an  ardent  attachment  undoubtedly  exposes 
to  great  excesses,  and  it  is  not  less  evident  that  these  excesses  may 
become  hurtful ;  but  they  are  not  so  much  so  as  if,  were  it  possible, 
the  same  individual  had  committed  them  with  perfect  indifference. 
This  is  easily  explained  by  referring  to  the  excitement  which  the 
whole  economy  receives  from  feelings  of  joy  and  pride. 

The  sensations  are  more  lively  in  proportion  as  the  semen  is  better 
formed,  and  has  remained  (within  certain  limits)  longer  in  its  reser- 
voirs. The  excitement  caused  by  its  long  continued  presence,  may 
even  proceed  so  far  as  to  bring  on  a  state  of  erotic  fury  almost  resem- 
bling mania.  On  the  other  hand,  the  sensations  lose  their  acuteness 
when  the  semen  begins  to  lose  its  stimulating  properties,  and  coitus 
becomes  more  and  more  insensible,  in  proportion  as  the  semen  be- 
comes more  watery.  All  those  who  have  consulted  me  in  conse- 
quence of  spermatorrhoea  following  venereal  excesses,  had  remarked 
this  diminution  of  pleasure  long  before  any  change  took  place  in  their 
health.  At  the  same  time  that  the  sensations  diminish,  the  erections 
become  less  perfect,  and  of  shorter  duration  ;  they  may  even  become 
so  precipitate,  that  intromission  is  impossible.  However  rarely  prac- 
tised, coitus  now  is  always  followed  by  serious  and  general  disorder, 
which  passes  off  very  slowly,  sometimes  even  continuing  ten  days  or 
a  fortnight. 

The  diminution  of  pleasure  is,  therefore,  the  first  sign  which  indi- 
cates that  the  individual  has  exceeded  the  limits  of  his  real  wants. 
The  danger  increases  with  the  imperfection  of  the  act. 

What  I  have  just  stated  is  applicable  to  all  seminal  discharges,  in 
whatever  manner  they  may  be  produced  ;  but  by  comparison,  it  be- 
comes clear,  that  they  are  more  dangerous  in  proportion  as  they  take 
place  with  less  energy  and  afford  less  pleasure. 

I  need  not  repeat  what  I  have  already  stated  respecting  the  effects 
of  coitus,  as  compared  with  those  of  masturbation  ;  most  surgeons 
agree  on  this  point ;  but  the  same  differences  exist  with  regard  to 
involuntary  discharges.  The  same  individual  who  could  repeat  coitus 
several  times  without  inconvenience,  often  feels  worn  out  after  a  sin- 
gle nocturnal  pollution.  Advantage  is  always  found  to  arise  from 
substituting  the  natural  mode  of  dischage  for  nocturnal  pollutions, 
when  those  do  not  arise  from  irritation.  The  normal  excitement 
resulting  from  coitus  in  such  cases,  gives  tone  to  the  whole  economy, 


VENEREAL    EXCESSES.  191 

and  especially  to  the  genital  organs ;  the  discharges  that  take  place 
are  more  easily  compensated,  and  contraction  of  the  ejaculatory 
ducts  more  actively  opposes  involuntary  discharges.  Nocturnal 
pollutions,  on  the  contrary,  leave  the  tissues  in  a  state  of  atony, 
increase  the  relaxation  of  the  ejaculatory  ducts,  and  expose  the  pa- 
tient to  a  return  of  the  same  accidents,  and  afterwards,  to  diurnal  pol- 
lutions. When  nocturnal  pollutions  arise  from  irritation  of  the 
genital  organs,  coitus,  by  increasing  that  irritation,  proves  injurious  ; 
but  when  they  are  due  to  habit  or  to  relaxation  of  the  parts,  coitus, 
even  when  often  repeated,  is  of  service  as  a  substitute  for  them. 

Nocturnal  pollutions,  when  compared  together,  are  liable  to  the 
same  observations.  All  the  patients  who  have  consulted  me  in  such 
cases,  have  noticed  that  at  first  the  emissions  were  accompanied  with 
dreams,  violent  erections,  and  lively  sensations,  and  that  they  were 
then  borne  without  injury ;  but  that  in  proportion  as  these  pheno- 
mena of  excitement  diminished,  the  pollutions  produced  more  serious 
and  lasting  effects.  Those  which  took  place  without  erection  or 
sensation  were  the  most  depressing.  Diurnal  pollutions,  too,  cceteris 
'paribus,  are  more  serious  and  more  difficult  of  cure  than  nocturnal 
ones ;  and  those  which  accompany  the  discharge  of  urine  are  more 
distressing  than  such  as  take  place  during  efforts  at  stool.  In  a 
word,  experience  has  convinced  me  that  involuntary  seminal  dis- 
charges are  serious  in  proportion  as  they  occur  easily. 

To  sum  up  then :  whether  the  excitement  arise  from  the  cerebral 
system,  the  passions,  &c.,  or  from  the  presence  of  well  formed  semen, 
emissions  accompanied  with  the  most  energetic  phenomena  can  alone 
be  useful  or  uninjurious  :  and,  cseteris  j^aribus,  seminal  discharges  are 
more  hurtful  in  proportion  as  they  are  accompanied  by  less  ener- 
getic erections,  and  less  lively  sensations  :  in  a  word,  as  they  are 
more  j^assive. 

I  consider  it  of  some  importance  thoroughly  to  establish  this  as 
a  general  principle,  both  because  it  is  opposed  to  the  ideas  usually 
entertained  on  the  subject,  and  because  it  is  of  daily  application  to 
the  study  and  treatment  of  both  voluntary  and  involuntary  seminal 
discharges. 

Accidental  injluences. — I  have  already  spoken  of  the  immediate 
efi'ects  of  horse  exercise,  and  alcoholic  stimulants,  as  well  as  the 
remote  ones  of  masturbation,  and  blennorrhagia.  One  or  two  phe- 
nomena arising  during  sleep,  deserve  mention. 

Accumulation  of  urine  in  the  bladder  during  the  night,  is  a  power- 
ful cause  of  excitement  of  the  genital  organs — another  proof  of  the 
intimate  connection  between  the  genital  and  urinary  systems.  This 
influence  is  well  known  to  all  who  suffer  from  nocturnal  pollutions  ; 
nearly  all  such,  warned  by  their  own  observations,  take  care  to  empty 
the  bladder  before  going  to  bed,  and  every  time  they  wake.  Some 
even  get  into  the  habit  of  waking  at  stated  periods  for  this  purpose, 
and  abstain  from  taking  fluids  in  the  evening.  Others  have  told  me 
that  the  presence  of  feces  in  the  rectum  produces  the  same  efi'ects. 


192  CAUSES    OF    SPERMATORRHCEA. 

The  heat  of  the  bed  is  also  a  powerful  stimulus  to  the  genital  organs. 
It  is  not,  therefore,  surprising  that  the  morning  should  be  the  period 
most  to  be  feared  by  those  addicted  to  masturbation,  or  tormented 
by  nocturnal  pollutions.  Such  erections,  in  most  cases,  do  not  arise 
from  real  wants,  and  therefore  coitus  becomes  injurious.  The  act 
is  indeed  more  or  less  an  excess  according  to  the  weakness  of  the 
individual,  and  must  be  avoided. 

General  Effects  of  Venereal  Excesses. — From  the  most  re- 
mote ages  a  striking  contrast  has  existed  between  the  inhabitants  of 
the  east  and  those  of  the  west.  The  following  characters  mark  the 
different  types.  On  the  one  hand,  their  habitual  idleness  and  inac- 
tivity ;  dread  of  physical  disturbance,  or  moral  agitation  ;  of  change 
of  any  kind  ;  and  of  all  employment  either  of  the  body  or  mind ;  a 
dreamy  existence ;  the  life  passed  apart  from  men,  and  shut  up 
among  women ;  while  on  the  other  hand,  their  restless  and  constant 
activity  ;  love  of  independence  and  liberty  ;  an  active  life  ;  aptitude 
for  business ;  love  of  glory  and  aggrandizement ;  boldness  and  per- 
severance in  enterprise  ;  devotion  to  country  and  to  principles  ;  ardent 
desire  of  improvement,  and  of  conquest,  both  by  prudence  and  in- 
dustry, and  by  war  and  colonization,  by  the  patient  observation  of 
facts,  and  by  the  constant  searching  after  truth.  These  characters 
have  continued  among  all  the  changes  of  religion  and  politics,  and 
are  even  more  marked  than  ever  at  the  present  day.  Considering 
all  circumstances,  the  differences  appear  to  me  to  arise  almost  en- 
tirely from  the  difference  between  the  eastern  and  western  nations 
in  respect  to  marriage.  On  the  one  hand,  there  is  polygamy,  and 
on  the  other,  monogamy.  Throughout  the  east  polygamy  is  encou- 
raged ;  hence  we  see  cowardly  despots  with  crowded  harems  among 
the  rich,  and  an  impoverished  and  debased  population,  with  a  scarcity 
of  females  among  the  poor ;  from  the  latter  circumstance  the  most 
revolting  vices  arise.  In  the  west,  on  the  contrary,  monogamy  is  a 
strictly  preserved  institution  ;  and  we  have  domestic  felicity,  moderate 
governments,  energetic  and  active  lives  ;  science  flourishes  ;  and  the 
western  nations  have  gradually  become  the  mistresses  of  the  world. 

A  circumstance  remarked  by  many  travellers  in  the  east  is,  the 
anxiety  with  which  cantharides  and  all  other  aphrodisiacs  are  sought 
after.  Impotence  arising  from  venereal  excesses  is  common  at  an 
early  age.  The  generative  functions,  then,  appear  to  possess  a  very 
powerful  and  direct  influence  on  the  state  of  society,  by  affecting  the 
physical  and  moral  strength  of  those  who  compose  it. 

Special  Effects  of  Venereal  Excesses. — The  influence  of  venereal 
excesses  in  producing  involuntary  seminal  discharges  was  perfectly 
well  known  to  Hippocrates  :  it  is  probable,  however,  that  he  was  aware 
of  other  causes. 

How  do  venereal  excesses  act  in  inducing  spermatorrhoea  ?  By 
the  influence  of  habit  ?  by  causing  atony  and  relaxation  of  the  parts  ? 
Doubtless  we  must  take  these  circumstances  into  consideration  ;  but 
there  is  a  much  more  serious  and  much  more  frequent  one.     The 


VENEEEAL    EXCESSES.  193 

local  phenomena  that  immediately  follow  coitus,  may  be  modified  by 
the  circumstances  which  preceded  or  accompanied  the  act;  but  they 
always  present  more  or  less  increased  action  in  the  genital  organs  ; 
the  effects  that  result  may  then  be  referred  to  excitement,  to  irrita- 
tion, or  even  to  inflammation. 

Whilst  the  organs  are  healthy,  and  intercourse  is  proportioned  to 
the  wants  of  the  system,  its  eff"ect  is  simply  tonic  and  stimulant. 
The  semen  is  more  abundantly  secreted  and  more  energetically 
retained  in  the  seminal  vesicles,  and  so  far  the  influence  is  useful, 
being  within  proper  bounds.  Coitus  therefore  is,  under  favorable 
circumstances,  the  natural  excitement  of  the  genital  organs. 

This  is  not  the  case  with  regard  to  masturbation,  and  the  other 
abuses  of  which  I  have  spoken,  and  hence  such  habits  are  so  perni- 
cious. Disturbance,  disorder,  and  irritation  alone  result  from  unna- 
tural abuses  ;  a  tonic  effect  is  never  produced.  Intercourse,  there- 
fore, is  substituted  with  advantage  for  either  voluntary  or  involun- 
tary discharges,  so  long  as  there  is  no  irritation  in  the  organs,' but 
when  irritation  has  once  been  set  up,  intercourse  always  increases  the 
nocturnal  and  diurnal  pollutions.  A  single  connection,  if  there  be 
irritation  of  the  organs,  may  produce  the  most  unfavorable  results. 
Excesses,  therefore,  when  the  organs  are  healthy,  (To  not  produce 
their  effects  at  first.  But  when  they  have  been  continued  for  some 
little  time  symptoms  of  irritation  supervene,  ejaculation  takes  place 
very  rapidly,  and  there  is  often  heat  felt  during  micturition  ;  the 
urine  is  more  abundant,  and  there  is  frequent  desire  to  pass  it ;  the 
orifice  of  the  urethra  is  red  and  injected.  This  irritation  extends  to 
the  prostate  and  margin  of  the  anus,  as  shown  by  a  feeling  of  weight 
and  uneasiness  in  the  rectum  and  perineum,  and  by  contraction  of 
the  sphincter  ani,  producing  constipation.  The  spermatic  cords  and 
testicles  are  painful  on  pressure,  and  require  to  be  supported  by  a 
bandage. 

Sometimes  chronic  or  even  acute  inflammation  of  the  urethra  may 
arise.  In  1831,  I  was  consulted  by  a  peasant,  about  thirty  years  of 
age,  for  urinary  fistula  in  front  of  the  scrotum.  He  married  at  the 
age  of  twenty-two,  and  never  had  intercourse,  except  with  his  wife, 
who,  on  the  other  hand,  never  suffered  from  leucorrhoea,  or  vaginal 
discharge.  The  patient  committed  such  excesses,  that  soon  after  his 
marriage  inflammation  of  the  urethra  came  on ;  this  was  situated 
chiefly  in  the  spongy  tissue,  for  there  was  very  little  discharge,  and 
the  chordee  very  severe.  The  passage  of  urine  became  diflicult,  and 
an  abscess  formed  and  broke  in  front  of  the  scrotum.  From  careful 
and  repeated  examinations,  I  am  convinced  that  the  urethra  was 
completely  obliterated  to  the  extent  of  five  or  six  lines,  about  half 
an  inch  in  front  of  this  fistula.  The  inflammation  in  this  case  then 
must  have  been  severe,  and  it  would  appear  that  it  was  produced 
solely  by  excessive  coitus. 

The  inflammation  of  the  prostate  is  not  always  confined  to  its 
mucous  follicles  ;  it  extends  sometimes  to  the  cellular  tissue  unitino- 


194  CAUSES    OF    SPERMATORRHCEA. 

them.  Hence  results  more  or  less  severe  and  complete  retention  of 
urine.     In  such  cases  catheterism  should  be  avoided  if  possible. 

Venereal  excesses  may  also  produce  acute  or  chronic  cystitis.  I 
have  lately  treated  a  severe  case  of  chronic  cystitis,  which  had  lasted 
five  years  and  came  on  soon  after  a  second  marriage  at  the  age  of 
forty-five. 

I  have  also  several  times  met  with  symptoms  of  nephritis  in  indi- 
viduals who  had  committed  great  excesses,  and  in  whom  no  other 
appreciable  cause  seemed  to  have  acted. 

Inflammation  of  the  vasa  deferentia  and  testicles  is  by  no  means 
rare  as  a  sequal  to  venereal  excesses.  The  manner  in  which  such 
inflammation  is  produced  is  well  known. 

Serious  effects  are,  however,  by  far  the  most  rare.  I  have  not 
laid  stress  on  them  in  order  to  show  what  ordinarily  occurs,  but  that 
which  takes  place  when  the  symptoms  are  less  severe  may  be  under- 
stood. Since  irritation  from  venereal  excesses  passes  so  readily  to 
the  prostate  and  bladder,  the  seminal  vesicles  cannot  escape,  and 
this  explains  why  involuntary  emissions  supervene.  It  is  evident 
also  from  this  fact  that  the  involuntary  discharges  do  not  arise  from 
atony  or  relaxation. 

It  is,  however,  diflicult  exactly  to  determine  where  the  excitement 
of  the  genital  organs  that  follows  coitus  begins  to  pass  into  irritation. 
As  it  is  of  much  importance  to  decide  this  point,  I  shall  describe  the 
most  usual  symptoms  that  are  manifested  during  the  change. 

At  first  the  erections  are  more  frequent  and  more  energetic,  and 
lead  to  a  belief  in  a  vigor  which  does  not  exist.  New  excesses  are 
committed  at  a  period  when  intercourse  ought  to  be  left  off. 

Frequent  desire  of  micturition  is  the  symptom  that  most  frequently 
precedes  involuntary  discharges  produced  by  venereal  excesses.  I 
have  frequently  been  consulted  by  patients  for  this  symptom  alone, 
who  had  already  suffered  in  health  from  unsuspected  spermatorrhoea. 

The  changes  in  the  phenomena  of  the  act  also  merit  serious  at- 
tention. The  erections,  after  having  been  frequent,  long  continued 
and  importunate,  become  rare,  incomplete,  and  of  short  duration  ; 
ejaculation  takes  place  with  increasing  rapidity,  so  that  at  length 
intromission  is  scarcely  possible.  The  sensations  also  diminish  in  a 
very  remarkable  manner,  and  coitus  becomes  very  fatiguing. 

The  first  changes  announce  that  irritation  is  being  set  up  by  the 
over  excitement  of  the  parts  ;  the  second,  that  diurnal  pollutions 
have  already  occurred. 

AVhen  these  symptoms  first  show  themselves,  the  disorder  would, 
in  many  cases,  be  arrested  spontaneously,  provided  the  patients  would 
put  a  check  on  their  desires.  This  rarely  occurs,  however  ;  and  on 
the  other  hand,  most  of  those  who  have  sufficient  power  over  them- 
selves to  preserve  absolute  continence,  suffer  at  first  from  nocturnal 
pollutions,  which  cause  them  to  relapse. 

But  as  the  economy  becomes  weaker,  the  patients  are  more  conti- 
nent; their  desires  diminish  ;  their  nocturnal  pollutions  are  less  fre- 


YEXEEEAL    EXCESSES.  195 

qnent,  and  at  length  cease  altogether,  being  replaced  by  diurnal  ones. 
The  patients  are  now  strictly  continent,  yet  derive  no  benefit ;  and 
hence,  they  often  believe  that  the  disorder  of  their  health  has  caused 
the  diminution  in  their  virility.  Some  patients  have  no  nocturnal 
pollutions,  or,  at  all  events,  such  pollutions  continue  a  very  short 
time ;  this  arises  from  their  tendency  to  constipation.  The  efforts 
necessary  at  stool  bring  on  emissions  rare  at  first,  but  afterwards 
frequent  and  abundant,  in  spite  of  enemata,  and  even  when  diarrhoea 
takes  the  place  of  constipation.  In  a  short  time  these  discharges 
occur  also  during  the  emission  of  urine. 

Patients  rarely  have  any  suspicion  of  such  evacuations  ;  and  when 
their  health  is  so  much  deranged  that  they  obtain  medical  aid,  they 
are  unable  to  give  any  exact  details  as  to  the  origin  of  their  disorder. 
According  to  the  symptoms  most  apparent,  therefore,  the  practitioner 
consulted  diagnoses,  chronic  gastritis,  commencing  cardiac  disease, 
threatening  apoplexy,  or  pulmonary  irritation.  He  bleeds,  or  ap- 
plies leeches  and  blisters :  if,  on  the  other  hand,  he  considers  the 
case  one  of  hypochondriasis,  he  prescribes  mineral  waters,  amuse- 
ments, travelling,  &c.  Still  the  disorder  progresses,  or  at  least,  only 
a  momentary  amelioration  occurs  ;  consultations  are  held,  but  if  any 
suspicion  of  venereal  excess  arise,  it  is  always  overthrown  by  the 
specious  objection  of  which  I  have  already  spoken,  while  describing 
the  effects  of  masturbation,  viz :  that  intercourse  has  ceased  for  a 
long  time,  and  that  the  health  has  from  that  period  become  still 
more  disordered.  The  details  given  are  precise  and  circumstantial ; 
the  patient  has  high  interest  in  confessing  all  the  truth  ;  he  has 
nothing  shameful  to  hide;  his  statement  is,  therefore,  received 
without  hesitation  by  his  medical  attendants.  Hence  we  may  ima- 
gine the  errors  which  are  likely  to  arise  in  the  treatment  of  these 
cases. 


(    196     ) 


CHAPTER  VIII. 

CAUSES  OF  SPERMATORRHCEA. 

Action  of  Certain  Medicines. 

Certain  medicines — as  astringents,  purgatives,  narcotics,  stimu- 
lants, and  diuretics  especially — may  bring  on  conditions  from  which 
spermatorrhoea  may  arise. 

^flstringents. 

CASE  XLVI. 

Intermittent  fever — Large  doses  of  Jjoi-h — Obstinate  con&tijwtion — Diurnal 
pollutions — Symptoms  of  chronic  gastritis,  and  of  disease  of  the  heart — 
Tlie  use  of  douches  followed  hy  rapid  improvement. 

M.  S ,  an  oflBcer,  about  thirty  years  of  age,  consulted  me  in  1828, 

for  supposed  disease  of  the  heart,  from  which  he  had  suffered  for  about 
eighteen  months.  He  was  tall,  thin,  and  very  pale  j  his  voice  husky,  and 
his  manners  timid.  On  examining  the  cardiac  region  with  the  stethoscope, 
I  found  that  the  pulsations  were  rapid  and  tumultuous,  and  occasionally 
intermittent  and  irregular,  but  there  was  neither  abnormal  force  nor  extent 
of  action,  and  there  was  no  friction  sound,  nor  bruit  de  souffle.  The  palpi- 
tations were  much  increased  by  active  exercise,  especially  by  mounting  a 
hill,  but  they  came  on  frequently  whilst  the  patient  was  in  a  state  of  absolute 
repose,  being  excited  by  any  unexpected  noise,  or  by  slight  moral  emotion. 

1  was  convinced  that  M.  S had  no  organic  disease  of  the  heart,  and 

soon  after  he  had  been  told  so,  his  pulse  assumed  its  normal  characteristics. 
He  gave  me  the  following  history  of  his  case. 

During  the  winter  of  1826,  whilst  at  Corsica,  he  assisted  in  extinguishing 
a  fire  which  occurred  during  the  night,  and  took  a  severe  chill.  Shortly 
afterwards,  he  suffered  from  a  very  obstinate  intermittent  fever,  for  which 
he  took  large  quantities  of  bark,  always  in  the  form  of  bo%ses.  From  this 
period,  he  became  subject  to  obstinate  attacks  of  constipation,  his  stomach 
became  very  irritable,  and  his  digestion  disordered.  Several  times  he  had 
symptoms  of  chronic  gastritis,  which  was  treated  by  leeches,  antiphlogistic 
regimen,  and  baths.  At  length  palpitations  and  difficulty  of  breathing  came 
on  gradually,  tending  to  create  a  suspicion  of  cardiac  disease,  to  combat 
which,  small  bleedings  were  frequently  practised,  and  digitalis  given  without 
benefit.  The  patient  attributed  his  constipation  and  digestive  disorder  to 
the  bark  he  had  taken,  and  the  disorder  of  his  heart  to  the  excitement  he 
had  experienced  during  the  fire. 


ACTION    OF    CERTAIN    MEDICINES.  197 

By  a  little  attention,  I  discovered  the  mode  in  which  the  bark  taken  had 
induced  the  symptoms  the  patient  suffered  from ;  obstinate  constipation 
supervening,  brought  on  involuntary  emissions  during  defecation ;  these 
were  at  first  slight  and  rare,  but  they  afterwards  became  more  abundant, 
and  after  a  time  quite  habitual,  notwithstanding  the  frequent  use  of  ene- 
mata.  The  patient  had  been  aware  of  these  discharges  from  their  com- 
mencement, but  he  attributed  them  to  his  prolonged  continence.  The  urine 
also  frequently  contained  semen.  On  the  other  hand,  his  erections  had 
diminished  by  degrees,  and  had  left  him  entirely,  together  with  his  venereal 
desires,  for  more  than  a  year.  He  had  never  committed  any  excess,  or  prac- 
tised any  abuse,  and  had  never  had  either  blennorrhagia  or  syphilis. 

Cold  ascending  douches,  iced  milk  mixed  with  lime  water,  and  cold 
lotions  on  the  perineum,  produced  a  rapid  improvement,  and  the  season  for 
using  mineral  waters  having  arrived,  I  advised  the  springs  of  Bareges. 
From  that  time  I  have  had  no  communication  from  the  patient. 

Palpitations  in  this  case,  as  in  many  others  that  I  have  related, 
arose  from  diurnal  pollutions.  These  discbarges  could  only  have 
been  caused  by  straining  at  stool,  the  patient's  constipation  being 
evidently  attributable  to  the  prolonged  use  of  bark  in  substance. 
From  analogy  we  may  suppose  that  many  other  remedies  may  pro- 
duce the  same  effects. 


Purgatives. 

I  have  already  shown  that  irritation  from  spasmodic  contractions 
of  the  rectum  may  extend  to  the  seminal  vesicles,  and  produce  just  as 
serious  diurnal  pollutions  as  those  which  arise  from  mechanical  com- 
pression of  the  same  organs.  Therefore,  if  ascarides,  diarrhoea,  ifec, 
can  excite  involuntary  emissions,  as  well  as  a  mechanical  obstacle 
to  defecation  does,  we  may  easily  understand  that  drastic  purgatives, 
by  irritating  the  rectum,  may  expose  the  patient  to  the  same  dangers 
as  astringents  do  by  bringing  on  constipation.  Drastic  purgatives,  as 
is  well  known,  act  chiefly  by  irritating  the  large  intestines.  Spasmodic 
contractions  of  the  rectum  may,  therefore,  be  excited,  and  may  induce 
.diurnal  pollutions,  the  severity  of  which  will  be  proportioned  to  the 
extent  and  duration  of  the  irritation,  but  as  this  irritation  usually  con- 
tinues a  very  short  time,  the  seminal  discharges  which  result  from  it 
scarcely  deserve  to  be  considered  as  a  disease.  It  is,  however,  easy 
to  conceive  that  the  too  frequent  repetition  of  drastic  purgatives,  or 
their  too  active  character,  may  bring  on  in  the  rectum  and  neighbor- 
ing parts,  a  more  permanent  state  of  irritation,  which  may  become 
habitual,  and  may  continue  after  the  cessation  of  its  exciting  cause. 

If,  however,  the  abuse  of  purgative  medicines  may  bring  on  sper- 
matorrhoea in  persons  not  previously  affected  by  it,  it  is  evident  that 
those  who  were  previously  affected  by  the  disorder,  must  be  much 
injured  by  their  use.  This  fact  becomes  very  important,  because  in 
almost  all  cases  of  spermatorrhoea  the  constipation  is  very  obstinate, 
and  the  patients  regard  it  as  the  primary  cause  of  their  sufferings.  It 
13 


198  CAUSES    OF    SPEEMATOKRHCEA. 

is  to  obviate  this  constipation  that  they  seek  medical  advice;  and  the 
symptoms  of  hypochondriasis  and  cerebral  congestion  they  manifest, 
induce  the  gentlemen  consulted  to  administer  purgatives  freely.  The 
patients  themselves  constantly  recur  to  purgatives,  and  although 
often  worse  after  their  use,  they  hope  that  the  remote  effects  ■will 
prove  more  favorable.  Under  no  pretext  should  the  medical  at- 
tendant permit  the  administration  of  anything  more  active  than 
mild  laxatives  in  these  cases.  Indeed,  it  is  even  doubtful  whether 
laxatives  can  be  used  with  impunity. 

Narcotics. 
CASE  XLVII. 

Frequently  repeated  narcotism  at  the  age  of  sixteen  from  the  vapor  of  to- 
bacco— Dilatation  of  the  pupils — Vomiting — Constant  headache — Con- 
stipation— Nocturnal  and  diurnal  pollutions — Impotence — Cauterization 
at  the  age  of  nineteen — Rapid  recovery. 

M.  S ,  of  Stockholm,  short  and  stout,  and  of  lymphatico-sanguineoufs 

temperament,  enjoyed  escellent  health  from  childhood,  until  at  the  age  of 
sixteen,  he  entered  a  tobacco  manufactory  in  May,  1835,  and  was  employed 
in  a  small  room  were  newly  made  cigars  were  dried  at  a  high  temperature. 
At  least  ten  thousand  cigars  were  constantly  in  the  stove.      At  first,  M. 

S did  not  suffer  any  inconvenience,  because  the  doors  and  windows 

of  the  drying  room  were  left  open ;  but  about  the  beginning  of  November 
he  was  attacked  by  headache,  which  was  felt  principally  behind  the  ears. 
This  increased  by  degrees  in  severity  and  duration,  and  by  the  end  of  the 
winter  had  become  constant ;  the  patient  was  neither  able  to  employ  him- 
self during  the  day,  nor  to  sleep  by  night.  Leeches  were  applied  behind 
the  ears,  and  on  the  following  day  he  was  seized  by  general  indisposition, 
frequent  vomiting,  as  well  before  as  after  meals,  dilatation  of  the  pupils, 
and  constipation. 

From  this  time  the  patient  fell  into  a  profound  melancholy  ;  he  became 
excitable,  timid,  and  incapable  of  any  serious  occupation.  A  seton  was 
inserted  in  the  nucha,  and  the  application  of  leeches  was  repeated.  No 
improvement  took  place,  however,  and  blisters  were  applied  behind  his 
ears  :  these  were  followed  by  retention  of  urine.  Soon  afterwards,  weakness 
of  the  lower  extremities,  loss  of  flesh,  and  pallidity  of  the  countenance, 
were  added  to  the  patient's  other  symptoms.  The  mineral  springs  of 
Carlsbad  and  Ems,  and  the  use  of  sea  bathing,  with  cold  douches  on  the 
head,  relieVed  the  vomiting;  but  the  other  symptoms  still  continued. 

In  this  condition,  the  patient  came  to  consult  me  in  July,  1836.  From 
information  received  from  the  medical  gentleman  under  whose  care  the 
patient  had  been  at  Stockholm,  Paris,  &c.,  I  imagined  the  sea  bathing  had 
been  most  useful  of  all  the  means  previously  tried.     I  therefore  advised  M. 

S to  continue  taking  salt  water  baths  until  the  end  of  the  season,  and 

consequently  I  did  not  see  him  again  until  the  beginning  of  winter,  when 
his  weakness  was  much  increased ;  his  headaches  continued  unrelieved;  his 
countenance  was  pale  and  livid;  his  intellect  very  sluggish;  his  memory 
uncertain ;  his  sleep  short  and  broken,  with  constant  drowsiness ;  the  pupils 


ACTION    OF    CERTAIN    MEDICINES.  199 

extraordinarily  dilated,  and  vision  very  imperfect;  in  fact,  tbe  patient  seemed 
to  be  still  laboring  under  tbe  effects  produced  by  tbe  cigar  stove. 

The  primary  cause  of  this  patient's  condition  could  not  be  doubted ;  but 
the  effects  of  narcotic  poison  usually  pass  off  in  a  day  or  two.  In  this 
case,  on  the  contrary,  the  headache  had  been  combated  by  various  means 
for  two  years.  I  was,  therefore,  considerably  embarrassed  as  to  what  I 
should  advise,  when  accidentally  I  saw  the  patient's  urine.  I  was  much 
surprised  to  perceive  an  abundant  deposit  resembling  semen,  at  the  bottom 

of  the  vessel,  and  on  questioning  M.  S I  learned,  that,  although  he  had 

never  been  addicted  to  masturbation,  and  bad  very  rarely  had  sexual  inter- 
course, shortly  after  the  symptoms  of  narcotism  first  confined  him  to  his 
bed,  he  had  experienced  abundant  nocturnal  pollutions,  which  increased  in 
frequency.  In  November,  1836,  he  had  as  many  as  three  each  night ;  after 
this  they  gradually  decreased  in  frequency,  so  that  he  had  then  only  three 
or  four  weekly ;  he  remarked  that  he  was  always  worse  on  the  following 
day.  At  first  these  pollutions  were  accompanied  by  energetic  erections, 
and  lascivious  dreams ;  but  these  phenomena  had  greatly  diminished,  and 
the  pollutions  were  no  longer  appreciable,  except  by  the  marks  left  on  the 
patient's  linen.  For  a  long  time  M.  S had  neither  experienced  vene- 
real desires  nor  erections,  although  he  was  only  nineteen  years  of  age.  Spa 
water,  iced  drinks,  cold  lotions,  &c.,  having  produced  no  benefit,  in  the 
beginning  of  December  I  introduced  a  catheter.  The  sensibility  of  the 
urethra  was  such  that  I  determined  on  cauterizing  the  prostatic  surface.  I 
had  little  hope  of  benefit  arising  from  this  operation,  but  a  remarkable  effect 
was  produced.  From  that  moment  the  nocturnal  pollutions  became  more 
and  more  distant,  and  the  constipation  ceased  spontaneously.  On  the  tenth 
day  the  patient's  urine  was  perfectly  transparent,  and  from  that  time,  his 
headache,  which  had  been  unsuccessfully  treated  for  two  years,  disappeared 
entirely;  his  sight  became  gradually  stronger,  and  his  pupils  contracted; 

his   ideas   became  clearer ;    employment  was   sought ;    and  M.  S was 

soon  able  to  resume  his  occupation.  His  virility  returned  with  great  en- 
ergy ;  during  six  months,  obstinate  erections  were  established  every  night, 
and  often  during  the  day,  on  the  least  cause  of  excitement,  but  no  involun- 
tary discharges  took  place.  These  violent  erections,  arising  from  the  unac- 
customed retention  of  the  semen  in  its  reservoirs,  diminished  by  degrees ; 
the  wants  became  less  imperious,  and  the  functions  returned  to  their  normal 
condition. 

I  have  seen  M.  S frequently  since  his  recovery,  and  I  am  able  to 

state  that  during  two  years  his  health  has  been  perfect.  In  a  letter  which 
I  have  recently  received  from  him,  dated  Stockholm,  he  informs  me  that  the 
change  of  climate  has  not  been  injurious,  and  that  he  never  enjoyed  better 
health.  He  has  resumed  the  habit  of  smoking,  for  which  he  felt  insur- 
mountable disgust  during  his  illness. 

This  case  shows  very  clearly  the  injurious  influence  of  tobacco  on 
the  genital  functions.  The  question  arises,  whether  this  influence  is 
due  to  the  action  of  tobacco  on  the  cerebro-spinal  system,  or  to  the 
direct  action  of  the  agent  on  the  spermatic  organs  ?  The  first  symp- 
toms manifested  presented  all  the  characteristics  of  poisoning  by 
narcotic  substances ;  and  these  symptoms  were  very  intense,  and 
much  prolonged;  headache,  too,  was  constantly  present,  and  situated 


200  CAUSES    OF    SPERMATORRHEA. 

behind  the  ears :  these  circumstances  might  lead  us  to  suppose  that 
the  pollutions  were  caused  by  some  special  action  of  the  tobacco  on 
the  cerebellum.  But  cauterization  alone  arrested  the  spermatorrhcea ; 
the  effects  of  the  nitrate  of  silver  were  sudden,  complete,  and  perma- 
nent. Impotence  was,  in  a  few  days,  replaced  by  violent  and  pro- 
longed erections,  which  diminished  only  after  six  months ;  and  it  is 
worthy  of  notice,  that  the  cephalalgia  and  dilatation  of  the  pupils, 
which  had  continued  from  the  commencement  of  the  narcotism,  only 
disappeared  after  the  spermatorrhoea  had  been  relieved. 

There  was,  then,  an  idiopathic  affection  of  the  ejaculatory  ducts, 
which  was  cured  by  the  local  action  of  the  nitrate  of  silver ;  and  the 
cephalalgia,  dilatation  of  the  pupils,  &c.,  were  kept  up  by  the  invo- 
luiitary  seminal  discharges.  The  persistence  of  the  symptoms  for 
two  years  after  the  patient  was  removed  from  the  influence  of  the 
tobacco,  is  thus  explained. 

The  mode  in  which  certain  stupefying  poisons  act  on  the  economy, 
and  especially  the  dilatation  of  the  pupils,  might  induce  us  to  believe 
that  the  spermatorrhoea  arose  from  relaxation  of  the  ejaculatory 

ducts  ;  but  in  the  case  of  M.  S ,  the  nocturnal  pollutions  were 

at  first  accompanied  by  phenomena  which  indicated  active  over- 
excitement  of  the  genital  organs.  The  application  of  blisters  was 
followed  by  retention  of  urine,  and  exacerbation  of  all  the  symp- 
toms ;  but  if  the  involuntary  discharges  had  arisen  from  relaxation, 
they  would  have  been  diminished  by  the  absorption  of  cantharides. 
The  excessive  irritability  present  in  the  urethra  too,  especially  near 
the  bladder,  leaves  no  doubt  as  to  the  existence  of  acute  irritation  in 
the  prostatic  portion  of  the  canal,  and  this  irritation  would  of  course 
extend  to  the  spermatic  organs.  Thus  we  may  account  for  the  re- 
markable success  of  the  cauterization. 


CASE  XLVIII. 

Nervous  temperament — Repeated  narcotism  heticeen  the  ages  of  twenty  and 
tv:enty-two  from  smoking — Impotence,  &c. 

I  have  a  young  man  of  very  nervous  temperament  at  present  under  my 
care,  in  whom  nocturnal  and  diurnal  pollutions  have  brought  on  pain  in  the 
loins,  palpitation,  difficulty  of  breathing,  &c.,  symptoms  which  were  sup- 
posed to  arise  from  disease  of  the  spinal  cord,  cardiac  affection,  and  com- 
mencing phthisis.  Among  the  exciting  causes  of  these  involuntary  dis- 
charges, the  effects  of  smoking  occupy  the  chief  place.  The  following  is 
the  patient's  statement. 

"  At  twenty  years  of  age  I  wished  to  accustom  myself  to  smoking ;  but  a 
day  never  passed  without  my  experiencing  complete  intoxication,  attended 
with  vomiting,  vertigo,  and  trembling  of  the  limbs.  I  continued  the 
habit,  however,  and  I  soon  began  to  perceive  that  my  sight  became  weak, 
and  that  I  lost  my  memory;  my  hands  shook;  and  my  digestion  became 
much  disordered.  I  noticed,  also,  great  debility  of  the  genital  organs ;  my 
erections  ceased  :  and  at  the  age  of  twenty-two  I  found  myself  completely 


ACTION    OF    CEETAIN    MEDICINES.  201 

impotent."  This  patient  had  rarely  practised  masturbation,  and  had  never 
committed  any  excess  when  he  first  began  to  smoke  ;  his  health  had  previ- 
ously been  excellent.  It  is,  therefore,  evident  that  the  impotence,  as  well 
as  the  other  symptoms,  arose  from  the  action  of  tobacco.  Impotence  at  the 
age  of  twenty-two  can  only  be  produced  by  involuntary  seminal  discharges, 
provided  there  be  no  physical  disability.  In  the  present  case,  there  was 
no  doubt  on  the  point,  the  patient  himself  having  discovered  diurnal  and 
nocturnal  pollutions.^ 

The  action  of  tobacco  on  those  ■who  smoke  for  the  first  time  is 
too  well  known  to  require  description  :  more  or  less  disorder  of  all  the 
functions,  varying  according  to  the  constitution  of  the  individual,  in- 
variably arises  from  it ;  and  this  disorder  always  presents  more  or 
less  of  the  characteristics  of  poisoning  by  narcotics.  These  effects 
go  off  by  degrees,  as  the  patient  becomes  habituated  to  the  use  of  to- 
bacco, and  generally  after  a  time  cease  to  be  manifested  at  all.  Some 
nervous  and  excitable  individuals  are  unable  to  accustom  themselves 
to  the  habit,  as  in  the  case  just  mentioned ;  in  others  again,  smoking 
becomes  an  artificial  habit,  which  in  many  cases  is  almost  a  necessity. 

But  this  empire  of  custom  has  its  limits,  beyond  which  the  nar- 
cotic influence  reappears.  In  such  as  are  not  easily  affected,  this 
acquired  habit  is  generally  supported  with  impunity ;  but  even  then, 
if  it  is  indulged  in  to  excess,  it  must  after  a  time  be  injurious. 
Thus  it  is  that  the  most  accomplished  smokers  often  experience 
vertigo,  cephalalgia,  anorexia,  &c.,  when  they  have  remained  long 
in  an  atmosphere  densely  filled  with  smoke,  which  is  then  drawn 
into  the  lungs,  and  probably  produces  worse  effects  than  when  merely 
drawn  into  the  mouth,  or  swallowed,  as  in  smoking. 

In  a  word,  then,  if  the  power  of  habit  can  prevent  the  momentary 
effects  of  smoking  from  showing  themselves,  the  frequent  repetition 
of  the  use  of  tobacco  produces  more  lasting  effects  on  different  or- 
gans. Disorder  of  the  digestive  organs  is  well  known  as  occurring 
in  inveterate  smokers  ;  that  of  the  genital  organs  has  not  hitherto 
been  noticed.^     I  believe,  however,  that  it  is  by  no  means  rare. 

Cantharides. 

I  have  already  noticed  that  the  application  of  a  blister  frequently 
contributes  to  increase  or  develop  involuntary  seminal  discharges. 
But  cantharides  are  not  employed  as  a  blistering  agent  only ;  they 
have  been  administered  internally  for  the  relief  of  impotence  and  to 
cure  seminal  discharges,  which  have  been  supposed  to  arise  from 
atony  or  relaxation  of  the  genital  organs.  None  of  the  patients  by 
whom  I  have  been  consulted  had  ever  received  even  momentary 
benefit  from  the  administration  of  cantharides;    many  experienced 


'  This  case  being  still  under  treatment,  I  have  omitted  its  further  details. 
-  Many  inveterate  smokers  among  my  professional  friends,  liave  mentioned  to  me 
the  diminution  of  their  venereal  desires,  as  one  of  the  effects  of  tobacco.  [H.  J.  McD.] 


202  CAUSES    OF    SPERMATORRHCEA. 

serious  increase  of  all  their  symptoms — complete  impotence  taking 
the  place  of  weakness  of  the  organs.  One  patient  for  whom  an  in- 
jection into  the  urethra  of  tincture  of  cantharides  diluted  with  water, 
had  been  ordered,  received  no  benefit  from  any  of  the  means  I  could 
devise  for  the  cure  of  involuntary  discharges  brought  on  by  such 
imprudence.  The  unsuccessful  employment  of  cantharides,  in  cases 
of  spermatorrhoea,  might  be  taken  as  further  evidence,  were  any  re- 
quired, that  the  disease  does  not  generally  arise  from  atony,  or 
relaxation,  but  from  irritation  of  the  genital  organs. 

Oamphor. 

The  action  of  camphor  is  the  very  opposite  to  that  of  cantharides. 
It  is  by  sprinkling  camphor  over  blisters  that  the  irritating  action 
of  the  cantharides  on  the  genito-urinary  organs  is  avoided.  Cam- 
phor relieves,  more  than  any  other  remedy,  the  priapism  and  great 
pain  in  the  genito-urinary  organs  induced  by  the  internal  adminis- 
tration of  cantharides.  Hence  it  is  generally  and  with  reason  con- 
sidered as  an  anti-aphrodisiac. 

I  believe,  then,  that  in  moderate  doses  and  under  certain  circum- 
stances, camphor  may  be  employed  with  advantage  in  the  treatment 
of  spermatorrhoea;  I  have,  however,  remarked  that  in  too  large  doses, 
or  when  continued  for  a  long  time,  camphor  may  induce  more  or  less 
serious  and  obstinate  involuntary  discharges.  One  of  my  patients 
who  put  camphor  between  the  prepuce  and  the  glans  penis,  suffered 
from  such  serious  diurnal  pollutions  that  his  life  was  in  danger  ;  he 
had,  however,  previously  suffered  from  involuntary  discharges. 

Nitrate  of  Potass. 

I  should  not  mention  this  preparation  did  I  not  consider  it  neces- 
sary to  point  out  a  grave  error  in  the  opinions  generally  received 
respecting  its  action  on  the  genito-urinary  organs.  Nitrate  of  potass 
is  supposed  to  possess  the  property  of  quieting  the  organs,  and  of  re- 
moving venereal  desires.  Saline  mixtures  containing  nitrate  of  potass 
are  prescribed  every  day  for  the  relief  of  the  inflammatory  symptoms 
in  the  first  stage  of  blennorrhagia — there  cannot  be  a  greater  error. 
Nitrate  of  potass  is  also  regarded  as  a  diuretic,  because  ordinarly  it 
increases  the  flow  of  urine ;  and  this  is  precisely  why  its  sedative 
properties  should  be  doubted.  The  quantity  of  urine  can  only  be 
increased  by  stimulating  the  functions  of  the  kidneys,  or  in  other 
words,  by  acting  on  them  as  an  excitant ;  when  administered  in  too 
large  a  dose  it  produces  hematuria,  pain,  &c.  But  it  is  not  on  the 
kidneys  alone  that  nitre  produces  this  stimulating  effect;  it  increases 
all  inflammations  of  the  bladder,  whether  acute  or  chronic  ;  it  is  even 
contraindicated  in  the  most  simple  case  of  vesical  irritation. 

I  have  seen  nitrate  of  potass  produce  the  same  effects  in  diseases 
of  the  prostate ;  it  increases  the  stabbing  and  pricking  pains,  and  the 


ACTION    OF    CERTAIlSr    MEDICINES.  .    203 

sense  of  weight,  which  the  patient  always  feels  in  that  region.  The 
following  case  shows  that  nitre  may  act  in  the  same  manner  on  the 
urethra. 

A  merchant  of  Genes,  wishing  to  take  a  purgative,  sent  to  a  drug- 
gist for  an  ounce  of  sulphate  of  magnesia.  By  mistake  an  ounce  of 
nitrate  of  potass  was  returned  by  the  messenger  and  taken.  Violent 
inflammation  of  the  urinary  passages,  accompanied  with  a  discharge 
resembling  blennorrhagia  resulted,  swelling  took  place  in  about  the 
centre  of  the  urethra,  and  when  the  acute  stage  of  inflammation  had 
passed  off,  a  circumscribed  induration,  which  obstructed  the  discharge 
of  urine,  remained.  Twenty  years  afterwards  the  patient  still  suffered 
from  this  obstruction,  for  the  formation  of  which  there  had  been  no 
other  cause  than  the  inflammation  produced  by  the  nitrate  of  potass. 
The  patient  had  never  had  blennorrhagia,  either  before  or  after,  and 
had  never  suffered  any  injury  of  the  part. 

It  appears  then  that  the  nitrate  of  potass  acts  as  a  stimulant  of 
the  whole  urinary  apparatus,  and  it  is  at  least  probable  that  it  pro- 
duces the  same  effect  on  the  spermatic  organs.  I  am  led  to  this 
opinion  partly  by  analogy,  but  chiefly,  because  more  than  forty  of 
the  patients  whom  I  have  treated  for  involuntary  seminal  discharges 
had  taken  nitrate  of  potass  in  some  form  or  other,  and  all,  without 
exception,  found  themselves  worse  afterwards.  Many  of  them  also 
observed  the  same  effects  from  preparations  of  squill,  and,  in  fact, 
all  other  diuretics. 

Ergot  of  Rye. 

This  singular  production  seems  to  act  with  as  much  energy  on  the 
genital  organs  of  man  as  on  the  female  uterus.  In  the  districts 
where  spurred  rye  is  common,  and  the  peasantry  are  not  careful  to 
separate  the  diseased  grain  from  the  healthy,  the  men  show  a  con- 
siderable disposition  to  commit  venereal  excesses,  and  the  women 
frequently  abort.  The  population,  generally,  also  present  signs  of 
premature  decrepitude,  which  we  can  easily  imagine  may  arise  from 
involuntary  seminal  discharges  brought  on  by  the  excesses  they 
commit.-^ 

Coffee. 

The  effects  of  coffee  on  the  cerebro-spinal  system  are  well  known; 
but  sufficient  attention  has  not  been  paid  to  its  action  on  other  organs. 
Taken  in  moderate  quantities,  coffee  excites  the  bladder  and  kidneys, 
increases  the  secretion  of  urine,  and  renders  its  discharge  more  fre- 
quent.   It  acts  in  the  same  manner  on  the  spermatic  organs,  augments 


1  M.  Robert,  iu  the  Annales  de  Th^rapeutique,  relates  a  case  in  which  the  ergot 
of  rye  is  said  to  have  cured  spermatorrhoea,  after  cauterization  and  other  means  had 
failed.  The  medicine  was  given  in  pills  in  two  grain  doses,  combined  with  one  grain 
of  camphor.  One  of  these  pills  was  taken  twice  a  day.  The  details  of  the  case, 
however,  are  by  no  means  clearly  given.     [H.  J.  McD.] 


204  CAUSES    OF    SPEEMATOERHCEA. 

the  venereal  desires,  favors  erections  and  accelerates  ejaculations 
taken  in  excess,  however,  it  seems  to  produce  injurious  effects. 


CASE  XLIX. 

Excessive  use  of  coffee — Frequent  and  profuse  discharge  of  urine — Noctur- 
nal, and  afterwards  diiirncd,  pollutions — Impotence,  &c. — Cauterization 
— Sulphuretted  baths — Recover!/.' 

A  professor,  get.  thirty,  engaged  in  a  new  method  of  tuition,  had  recourse 
to  very  strong  coffee  to  keep  himself  awake,  and  took  eight  or  ten  cups 
every  night.  A  large  quantity  of  urine  was  secreted,  and  micturition 
was  much  increased  in  frequency.  After  a  few  weeks  the  desire  of  emptying 
the  bladder  became  so  frequent  and  imperious,  that  the  patient  was  obliged 
to  leave  his  class  several  times  during  their  meeting.  Soon  after  he  suifered 
from  constipation  and  disordered  digestion,  attended  with  great  discharge  of 
flatus.  His  intellect  and  memory  declined,  so  that  he  became  unable  to 
finish  his  course  of  instruction,  and  sleep  had  left  him  entirely,  although 
he  had  for  some  time  given  up  taking  coffee. 

On  his  consulting  me,  he  confessed  that  he  had  become  completely 
impotent,  after  having  experienced  frequent  and  abundant  nocturnal  pol- 
lutions, which  diminished  by  degrees,  and  had  not  appeared  for  three  months. 
I  found  his  urine  perfectly  transparent,  almost  colorless,  and  very  abundant; 
there  was  not  the  least  cloud  perceptible,  but  at  the  bottom  of  the  vessel 
there  were  numerous  transparent  granules,  which  left  no  doubt  as  to  the 
existence  of  diurnal  pollutions. 

Catheterism  showed  excessive  sensibility  of  the  urethra,  especially  near 
the  neck  of  the  bladder ;  and  on  this  account  I  performed  cauterization. 
The  operation  was  followed  by  rapid  improvement,  and  a  few  months  after- 
wards the  cure  was  perfected  by  the  use  of  sulphuretted  springs. 

It  is  evident  that  the  diurnal  pollutions  in  this  case  arose  onlj 
from  the  immoderate  use  of  coffee;  the  first  symptoms  appeared  soon 
after,  and  the  patient  had  been  subjected  to  no  other  cause  capable 
of  producing  this  affection.  The  irritation  continued  for  six  months 
after  he  had  left  off  taking  coffee  ;  thus  the  effect  was  prolonged 
quite  independently  of  its  first  cause,  and  in  a  manner  which  would 
lead  one  to  suppose  that  it  would  not  have  ceased  spontaneously. 

What  passed  in  the  urinary  organs  is  a  good  index  of  what  was 
going  on  in  the  spermatic  :  the  secretion  of  semen  was  increased  as 
well  as  that  of  urine,  and  its  excretion  also  became  more  frequent. 
The  nocturnal  pollutions  diminished  by  degrees,  because  they  were 
replaced  by  diurnal  ones,  which  became  more  and  more  frequent  and 
profuse.  Perfect  similitude,  therefore,  existed  between  the  urinary 
and  spermatic  symptoms ;  their  respective  progress  and  characters, 
and  the  extreme  sensibility  of  the  prostatic  portion  of  the  urethra, 
show  clearly  enough  the  mode  in  which  coffee  brought  on  spermator- 
rhoea. It  is  likely  enough  that  the  occasional  or  moderate  use  of  coffee 
should  stimulate  the  venereal  desires,  whilst  they  are  diminished,  and 


ACTION    OF    CEKTAIN    MEDICINES.  205 

even  completely  extinguished  by  it  when  taken  in  excess.  Its  ac- 
tion is  the  same  in  both  cases — that  is  to  say,  it  excites  the  genito- 
urinary organs. 

I  have  seen  many  other  cases  in  which  spermatorrhoea  followed  the 
immoderate  use  of  coffee,  but  other  causes  acted  simultaneously,  so 
that  the  effects  could  not  be  traced  so  distinctly  to  one  single  cause 
as  in  the  case  I  have  just  related.  Almost  all  the  patients,  however, 
were  scientific  or  literary  men  who  wished  to  keep  up  mental  activity, 
in  order  to  prolong  their  hours  of  study.  Some  of  these  patients 
recovered  by  the  use  of  baths  and  regular  active  exercise  combined 
with  a  strict  regimen  :  others  required  various  kinds  of  treatment — 
the  natural  sulphuretted  waters  being  the  most  generally  successful. 
Weak,  delicate,  and  excitable  constitutions  appear  most  easily  af- 
fected. 

Another  circumstance  having  reference  to  coffee  is  worthy  of 
notice.  All  those  who  have  consulted  me  for  serious  nocturnal  or 
diurnal  pollutions  had  given  up  its  use  of  their  own  accord  :  they 
noticed  that  after  taking  coffee  they  experienced  agitation,  disor- 
dered vision,  involuntary  contractions  in  their  muscles,  and  espe- 
cially a  notable  increase  in  the  secretion  of  urine,  and  in  the  invo- 
luntary seminal  discharges. 

Tea. 

Analogy  leads  me  to  suppose  that  tea  taken  in  excess  may  pro- 
duce the  same  results  as  coffee  ;  I  have  not,  however,  met  with  any 
well  marked  cases  illustrative  of  its  action.^ 

There  are  many  other  agents  which  may  excite  or  increase  in- 
voluntary seminal  discharges,  but  their  action  is  not  sufficiently  en- 
ergetic or  often  enough  repeated  to  cause  serious  disease.  I  do  not, 
therefore,  mention  them  specially  here,  but  shall  take  occasion  to 
comment  on  them  as  cases  present  themselves. 

I  have  now  examined  all  the  causes  of  involuntary  seminal  dis- 
charges which  act  from  without.  I  have  still  to  speak  of  those  causes 
which  may  be  attributed  to  the  influence  of  other  organs,  and  to 
congenital  predisposition. 


•  Experience  enables  me  to  confirm'  M.  Lallemand's  opinion,  as  to  the  injurious 
effects  of  tea  on  persons  affected  with  involuntary  seminal  discharges.  Several  of 
my  patients  had  discovered  that  tea  and  coffee  always  proved  hurtful  to  them,  and 
had  renounced  their  use  before  consulting  me.  Such  patients  have  found  no  ill  effects 
follow  the  use  of  cocoa.  I  have  not,  however,  met  with  any  case  in  which  the  origin 
of  involuntary  discharges  could  fairly  be  attributed  to  the  abuse  of  tea  or  coffee.  [H. 
J.  McD.] 


(    206     ) 


CHAPTER  IX. 

CAUSES  OF  SPERMATORRHCEA. 

Action  of  the  Cerebrospinal  System. 

Cerebellum.  I  have  already  stated  that  sexual  ideas  may  precede 
the  evolution  of  the  genital  organs,  and  always  remain  predominant, 
so  as  to  produce  a  kind  of  erotic  excitement  quite  disproportioned  to 
the  real  wants.  I  may  add  that  these  precocious  and  excitable  indi- 
viduals are  most  alive  to  the  diminution  of  their  virility.  In  general, 
when  this  diminution  arises  from  age,  it  is  insensible,  because  the  de- 
sires diminish  in  an  equal  proportion.  But  the  persons  I  have  de- 
scribed are  more  sensible  than  others  to  this  change,  and  when  it 
occurs  rapidly  and  prematurely,  it  produces  a  deep  impression  on 
them,  and  frequently  drives  them  to  commit  suicide. 

Most  surgeons  have  noticed  the  depression  of  spirits  caused  by 
amputation  of  the  penis  or  testicles ;  but  in  this  respect,  also,  there 
is  a  great  difference  between  different  individuals.  A  few  years  ago 
I  removed  the  penis  of  a  man,  set.  forty-five,  for  cancerous  disease. 
He  recovered,  and  was  fit  to  leave  the  hospital,  when  his  wife  came 
to  see  him  for  the  first  time  after  the  operation.  During  the  rest 
of  the  day  he  was  silent  and  sad,  and  the  following  morning  he  was 
found  dead.  A  post-mortem  examination,  made  with  the  utmost 
care,  failed  to  show  any  appreciable  lesions  of  important  organs. 

Such  striking  cases  of  despair  following  the  loss  of  the  functions, 
are  rare ;  but  it  is  very  common  to  see  grief  derange  the  health,  and 
thus  shorten  the  patient's  days.  Old  people,  from  whom  portions  of 
the  genital  organs  have  been  removed,  rarely  experience  this  moral 
impression.  I  have  always  noticed,  in  such  cases,  that  the  joy  of 
being  cured  is  not  broken  by  any  regret.  Whence  does  this  indif- 
ference to  the  loss  of  virile  power  arise,  if  not  from  the  weakening 
of  the  venereal  desires  produced  by  old  age. 

I  have  had  a  patient,  set.  thirty,  in  the  hospital  for  some  time,  who 
received  an  enormous  sabre  wound  on  the  nucha.  A  long  cicatrix 
exists  across  the  back  of  the  neck  from  ear  to  ear.  "Venereal  desire 
has  entirely  left  him,  and  his  testicles  are  atrophied.  Erections,  of 
course,  have  disappeared ;  yet  this  patient  experiences  more  pleasure 
at  having  reformed^  than  sorrow  at  the  loss  of  his  virility.  He  always 
jokes  when  speaking  of  the  wound  and  its  consequences.    I  can  only 


ACTION    OF    THE    CEREBRO-SPIN AL    SYSTEM.  207 

attribute  this  carelessness  to  his  sexual  ideas  having  left  him  at  the 
same  time  as  his  virile  powers. 

From  these  facts,  then,  I  conclude  that  the  generative  function 
requires  not  only  the  instruments  necessary  for  the  accomplishment 
of  intercourse,  but  the  organ  in  the  encephalon  destined  to  receive 
the  sensations  from  these  parts,  and  to  direct  their  functions ;  that 
these  two  systems  exercise  a  reciprocal  influence  over  one  another, 
in  which  influence  the  encephalic  organ  may  preponderate  either  con- 
stantly or  accidentally,  according  as  the  organ  is  developed  prema- 
turely, and  in  excess,  or  as  it  enjoys  a  momentarily  increased  activity. 

Gall  and  his  followers  have  regarded  the  cerebellum  as  the  organ 
of  ph3'sical  love  and  the  regulator  of  the  genital  functions,  and  on 
this  point  they  have  shown  more  unanimity  than  on  any  other ;  this 
is  not  the  place  to  discuss  the  correctness  of  their  hypothesis,  but  I 
must  say,  that  from  my  own  experience,  I  consider  it  at  least  probable. 


CASE  L. 

Masturbation — Extreme  weakness  of  the  limhs  and  senses — Erections  excited 
by  percussion  of  the  occiput — Catheters  left  in  the  urethra — Rapid  reco- 
very. 

Dubourdeaux,  aet.  twenty-one,  a  soldier  in  the  36th  regiment  of  infantry, 
of  strong  constitution,  practised  masturbation  at  the  age  of  fourteen  as 
often  as  three  or  four  times  a  day  without  much  injury  to  his  health.  At 
the  age  of  twenty,  he  entered  the  army.  A  few  months  afterwards,  he 
contracted  a  blennorrhagia,  and,  while  suffering  from  it,  performed  a  long 
march.  He  was  scarcely  cured  when  he  took  another  long  march,  bivouack- 
ing at  night,  for  about  a  month.  Otitis  occurred,  and  was  treated  with 
leeches  and  blisters,  but  ended  in  suppuration.  After  this  was  cured,  the 
patient  suffered  much  from  noise  in  the  ears  and  vertigo,  and  his  sight  be- 
came very  weak. 

On  the  21st  of  December,  1830,  D came  to  the  hospital  of  St.  Eloi, 

in  the  following  condition  :  itch ;  enlargement  of  the  prostate ;  sense  of 
weight  in  the  rectum;  extreme  weakness  of  all  the  limbs;  serous  infiltration  of 
the  hands,  legs  and  feet ;  and  almost  entire  loss  of  vision.  After  the  itch 
was  cured,  the  paralysis  of  the  inferior  extremities  increasing,  issues  in  the 
loins  were  prescribed,  but  produced  no  benefit. 

When  the  patient  came  under  my  care,  he  could  neither  stand,  nor 
disiinguish  the  numbers  on  the  beds  in  his  ward.  He  told  me,  that  on 
accidentally  striking  his  occiput,  he  had  experienced  a  lively  sensation  re- 
sembling that  produced  by  ejaculation,  together  with  injection  of  the  corpora 
cavernosa,  producing  more  or  less  complete  erection.  He  had  since  fre- 
quently repeated  percussion  of  the  occiput,  which  was  always  followed  by 
the  same  phenomena;  the  voluptuous  sensation  induced  seemed  to  pass 
through  the  whole  length  of  the  spinal  cord,  to  the  extremity  of  the  sacrum. 
Some  circumstances  leading  me  to  believe  that  the  patient  abused  this  dis- 
covery, and  practised  manoeuvres  he  did  not  admit,  and  the  swelling  of  the 
prostate  at  the  same  time  rendering  the  discharge  of  urine  difficult,  I  left 
catheters  in  the  bladder,  increasing  their  size  gradually,  and  taking  care  to 


.208  CAUSES    OF    SPERMATORRHCEA. 

withdraw  them  as  soon  as  sufficient  inflammation  had  been  excited,  and  to 
replace  them  when  the  pain  in  the  urethra  had  subsided. 

The  result  soon  convinced  me  that  my  suspicions  had  been  correct. 
By  degrees  the  paralysis  of  the  lower  extremities,  the  oedema  of  the  hands, 
and  the  weakness  of  vision  were  relieved.  After  introducing  the  catheter 
six  times  in  as  many  weeks,  the  patient  had  recovered  his  strength,  stout- 
ness, and  the  free  exercise  of  all  his  functions.  He  left  the  hospital  a  few 
days  after,  confessing  his  errors  and  promising  not  to  repeat  them. 

From  the  first  information  given  by  this  patient,  I  thought  that 
the  attack  of  otitis  had  probably  produced  some  chronic  affection  of 
the  brain  or  its  membranes,  but  the  sequel  showed  that  the  almost 
perfect  paralysis  of  the  lower  limbs,  the  swelling  of  the  hands,  and 
other  symptoms,  exclusively  arose  from  masturbation.  I  have  al- 
ready mentioned  the  advantages  derivable  from  the  presence  of  a 
catheter  in  the  urethra,  in  checking  masturbation  ;  but  in  the  present 
case,  a  very  remarkable  circumstance  offered  itself,  viz.,  the  influ- 
ence exercised  on  the  genital  organs  by  percussion  of  the  occiput. 
The  effects  of  this  procedure  were  so  constant,  that  the  patient  was 
able  to  procure  himself  erections  at  will,  and  to  give  himself  up  to 
his  passions  without  restraint. 

CASE  LI. 

SichJy  childhood — Nervous  temperament — Masturhation  rare — Coitus  still 
more  so — Symptoms  of  aneurism  and  gastritis — Nocturnal  pollutions — 
Predominance  of  erotic  ideas — Tension  at  the  nucha — The  application  of 
cold  lotions  to  this  region  followed  hy  considerable  improvement. 

A  tax-gatherer,  ast.  thirty-four,  of  nervous  temperament,  whose  childhood 
had  been  very  delicate,  from  his  having  suffered  from  digestive  disorder, 
with  frequent  vomiting,  consulted  me.  He  had  practised  masturbation 
occasionally  about  the  age  of  sixteen,  and  at  a  later  period  had  had  sexual 
intercourse,  but  never  more  frequently  than  three  or  four  times  a  week.  At 
eighteen  years  of  age,  he  suffered  from  palpitation  of  the  heart,  attended 
with  oppression  of  breathing,  pain  in  the  stomach,  and  involuntary  muscular 
contractions.  These  symptoms  gave  rise  to  suspicions  of  aneurism,  gastritis, 
&c.;  in  consequence  of  which,  frequent  abstractions  of  blood,  both  locally 
and  generally,  and  the  use  of  blisters  and  issues,  were  prescribed ;  with  the 
exception  of  the  issues,  these  means  all  proved  injurious.  The  blisters  evi- 
dently seemed  to  favor  the  occurrence  of  nocturnal  pollutions,  which  tqok 
place  three  or  four  times  a  week  about  this  time,  taking  the  place  of  volun- 
tary emissions.  Shortly  before  he  consulted  me^  this  patient  attempted 
sexual  intercourse  by  the  advice  of  his  physician,  but  found  himself  much 
worse  afterwards.  All  the  precautions  recommended  to  prevent  the  return 
of  the  nocturnal  pollutions  had  also  proved  unsuccessful,  and  the  patient 
had  remarked  that  these  were  more  debilitating  in  proportion  as  they  took 
place  with  less  signs  of  erection  or  feelings  of  pleasure.  Their  effects  were 
often  felt  for  several  days. 

The  extraordinary  presence  of  erotic  ideas  in  this  patient  struck  me 
forcibly.     Notwithstanding  the  small  development  of  the  genital  organs, 


ACTION    OF    THE    CEEEBKO-SPINAL    SYSTEM.  209 

notliing  could  remove  lascivious  images  from  his  imagination ;  they  were 
present  during  the  most  serious  study.  In  vain  he  gave  up  theatres  and 
amusements;  in  vain  he  had  recourse  to  serious  books,  and  religious  or 
scientific  discussions;  he  was  constantly  assailed  by  libidinous  thoughts, 
which  presented  themselves  under  a  variety  of  forms,  and  were  ever  present 
in  his  dreams.  He  experienced  also,  an  habitual  sense  of  tension  and  unea- 
siness in  the  posterior  and  inferior  region  of  the  head.  Of  all  the  means 
employed,  cold  lotions  applied  to  this  region  alone  produced  any  notable 
diminution  in  the  frequency  of  the  nocturnal  pollutions;  but  this  effect  was 
never  of  long  duration. 

In  this  patient  the  causes  by  no  means  tallied  with  the  serious 
effects  produced,  or  with  the  persistence  of  the  disease.  Numbers 
have  practised  masturbation  and  coitus  much  more  frequently  with- 
out experiencing  any  ill  effects.  On  the  other  hand,  the  constant 
presence  of  erotic  ideas  showed  an  activity  of  the  genital  instinct, 
which  was  by  no  means  in  relation  with  the  condition  of  the  genital 
organs.  The  sensation  referred  to  the  nucha,  and  the  effects  of  cold 
lotions  applied  to  this  part  seem  to  indicate  that  the  affection  was 
produced,  or  at  least  kept  up,  by  abnormal  excitement  of  the  cere- 
bellum. 

In  several  cases  of  involuntary  seminal  discharges,  I  have  found 
the  patients  complain  of  habitual  heat,  dull  pain,  and  sense  of  ten- 
sion in  the  occipital  region  ;  sometimes  accompanied  with  pulsation 
of  the  arteries.  One  of  my  patients  experienced  a  nocturnal  pollu- 
tion Avhenever  his  head  rested  on  a  soft  pillow.  I  must  admit,  that 
in  such  cases  I  have  not  obtained  much  success  by  using  applications 
to  the  nucha  and  its  neighborhood  ;  indeed,  I  have  only  once  seen 
temporary  improvement  result  from  this  treatment. 

On  the  other  hand,  these  symptoms  are  much  more  rare  than  any 
others  of  which  I  have  hitherto  spoken.  Thus,  for  example,  symp- 
toms which  "we  may  refer  to  the  brain,  are  much  more  frequently 
presented.  There  are  few  patients  who  do  not  experience  diminu- 
tion of  memory  and  intellect,  pain  in  the  frontal  region,  pulsation  in 
the  temporal,  and  weight  in  the  anterior  and  lateral  parts  of  the  head, 
with  attacks  of  vertigo,  dazzling  of  sight,  and  cerebral  congestion  ; 
some  even  have  serious  falls ;  and  the  integuments  of  the  face  are 
much  more  frequently  red  and  burning  than  those  of  the  nucha. 
Symptoms  of  chronic  stomach  disorder  are  still  more  common,  and 
it  is  by  no  means  extraordinary  to  see  accidental  irritation  of  the 
stomach  increase  or  re-excite  involuntary  seminal  discharges.  The 
influence  of  the  cerebellum  in  causing  spermatorrhoea  is,  therefore,  a 
subject  which  requires  further  research,  with  varied  and  numerous 
cases,  in  order  for  it  to  be  properly  understood. 

In  such  cases  my  experience  leads  me  to  recommend  the  applica- 
tion of  ice  and  leeches  to  the  nucha,  when  particular  symptoms  are 
observed  in  this  region,  or  when  other  means  have  failed.  But  in 
order  to  judge  the  effects  of  these  remedies  fairly,  it  is  necessary  to 
abstain  from  all  other  treatment  at  the  same  time,  and  to  guard 


210  CAUSES    OF    SPERMATORRHCEA. 

against  preconceived  opinions.  Exaggerated  opinions  have  done 
more  injury  to  the  truth  than  the  most  violent  opposition. 

It  is  impossible,  for  instance,  to  admit,  with  Gall,  Voisin,  Londe, 
Chauffard,  &c.,  that  we  should  always  direct  our  remedies  towards 
the  cerebellum  in  cases  of  satyriasis,  nymphomania,  &c,;  or  that  the 
cerebellum  is  always  the  origin  of  the  phenomena  which  take  place 
in  the  genital  organs.  Such  an  assertion  scarcely  requires  a  serious 
consideration.  It  is  hardly  necessary  to  refer  to  the  powerful  and 
immediate  influence  exercised  over  the  thoughts,  dreams,  venereal 
desires,  erectile  tissues — indeed,  over  all  the  functions,  and  all  the 
organs  of  the  economy — by  the  presence  of  well  formed  semen  in  its 
reservoirs.  Such  effects  are  seen  daily,  and  constantly,  and  have 
been  well  understood  for  a  long  time.  Ascarides,  by  causing  irri- 
tation in  the  rectum,  suffice  to  excite  long-continued  erections,  even 
in  children,  and  to  incline  towards  abuses  and  excesses  ;  or,  by  acting 
directly,  to  bring  on  debilitating  involuntary  emissions.  Sebaceous 
matter  retained  between  the  prepuce  and  glans,  may  produce  the 
same  effects.  In  women,  excision  of  the  clitoris  takes  away  the  pas- 
sion for  masturbation.  It  is  well  known  too,  that  the  presence  of  an 
eruption  on  the  labia  often  excites  nymphomania.  How  do  these  facts 
accord  with  the  opinions  of  those  who  would  refer  all  such  influence, 
and  would  direct  all  their  remedial  measures,  to  the  cerebellum  ? 

There  are  other  arguments  which  I  regret  to  see  incessantly 
brought  forward  to  prove  the  action  of  the  cerebellum  on  the  genital 
organs.  As  an  example  of  these,  I  may  mention  the  effects  which 
sometimes  accompany  apoplexy  of  this  organ. 

Gall  well  explains  the  proneness  to  masturbation  in  such  hydro- 
cephalic children  as  attain  the  age  of  puberty,  by  remarking  that 
this  affection,  acting  only  on  the  brain,  allows  the  cerebellum  a  pre- 
dominating influence.  This  deduction  seems  correct,  and  may  be 
applied  with  just  as  much  truth  to  idiots  and  cretins.  But  apoplexy 
of  the  cerebellum  instantly  abolished  the  function  of  the  part 
attacked  :  to  explain  pathological  erections  by  this  alteration,  and 
to  conclude  that  the  cerebellum  is  the  exciting  organ  of  the  genital 
functions  is,  therefore,  an  evident  contradiction.  Instead  of  laying 
stress  on  such  facts  as  these,  Gall  and  his  followers  should  have 
regarded  them  as  serious  objections  to  their  system ;  they  should 
have  sought  to  discover  how  erections  could  take  place  in  spite  of 
the  greater  or  less  destruction  of  the  cerebellum ;  they  would  then 
have  seen  that  such  erections  are  less  common  than  they  are  sup- 
posed to  be  in  cerebellar  apoplexy,  and  that  they  much  more  fre- 
quently accompany  injuries  of  the  spinal  cord,  &c. — circumstances 
which  the  adversaries  of  phrenology  have  taken  care  to  remark :  so 
true  is  it,  that  truth  makes  itself  known  by  all  ways. 

The  exaggeration  and  false  reasoning  that  have  obscured  all  dis- 
cussions relative  to  the  true  seat  of  the  genital  instinct  must  not,  how- 
ever, induce  us  to  forget  the  importance  of  pathological  facts.  What 
I  have  said,  should  make  the  profession  take  into  consideration  the 


ACTION    OF    THE    CEREBBO-SPINAL    SYSTEM.  211 

influence  the  cerebellum  may  possess  in  causing  involuntary  dis- 
charges of  which  they  are  unable  to  discover  the  cause,  especially 
when  such  discharges  are  accompanied  with  special  symptoms  re- 
ferred to  the  occipital  region. 

Spinal   Cord. 

The  opinion  has  been  given,  that  diurnal  pollutions  are  sometimes 
the  cause,  and  sometimes  only  a  symptom  of  atrophy  of  the  medulla 
spinalis.  The  following  case,  which  has  come  under  my  observation, 
I  think  throws  some  light  on  this  subject. 

A  private  in  the  engineers  wishing  to  get  out  of  his  barracks  to 
visit  a  female,  fell  from  a  great  height  on  his  buttocks.  Serious  con- 
cussion resulted,  but  no  fracture.  Notwithstanding  bleeding,  leeches, 
cupping,  issues,  &c.,  the  lower  extremities  remained  paralyzed. 
After  a  time,  however,  galvanism  restored  slight  motion,  and  obscure 
sensibility.  Still  the  glans,  the  prepuce,  and  skin  of  the  penis  and 
scrotum,  remained  completely  insensible.  Pinching,  and  pins  driven 
into  them  were  unperceived  by  the  patient.  Catheterism,  which  at 
first  was  frequently  necessary,  never  induced  complaints.  But 
chronic  vesical  catarrh  supervening,  I  cauterized  the  bladder  and  its 
neck,  and  this  operation  gave  just  as  much  pain  as  in  other  patients. 

The  same  phenomena  followed.  At  first  the  urine  was  sanguino- 
lent  and  thick,  but  soon  lost  this  appearance,  and  was  passed  with 
greater  force  and  facility.  Whilst  treating  this  patient,  I  often  found 
the  penis  in  complete,  and  indeed  remarkable  erection.  I  mentioned 
this  to  the  patient,  who  told  me  that  he  often  suffered  from  this  state 
of  priapism,  which  he  found  very  disagreeable  on  account  of  the  ob- 
stacle which  it  formed  to  the  discharge  of  urine.  In  order  to  relieve 
himself,  he  had  several  times  tried  masturbation,  but  had  never  been 
able  to  procure  ejaculation,  notwithstanding  the  erection  was  perfect, 
and  he  had  persevered  in  his  manoeuvres.  He  experienced  no  plea- 
sure, and  only  attempted  it  in  the  hope  of  relieving  the  priapism. 
Having  one  day  obtained  permission  to  leave  the  hospital,  he  visited 
the  female,  to  see  whom  he  had  scaled  the  barrack  walls  in  so  unfor- 
tunate a  manner.  He  passed  several  hours  with  her  in  almost  con- 
tinual connection,  without  being  able  to  procure  ejaculation,  and 
without  experiencing  the  least  sensation.  On  the  other  hand,  all  his 
functions  were  well  performed,  with  the  exception  of  slight  costive- 
ness  ;  he  gained  flesh  daily,  ahd  his  moral  faculties  were  not  afi'ected  ; 
abundant  nocturnal  pollutions  took  place  at  long  intervals,  and  were 
preceded  by  erotic  dreams,  but  accompanied  with  little  pleasure. 

This  case  shows  clearly  the  special  influence  of  the  spinal  nerves 
in  contradistinction  to  that  of  the  branches  of  the  sympathetic,  dis- 
tributed to  the  different  parts  of  the  genital  apparatus.  In  fact,  in 
this  patient,  all  the  phenomena  dependent  on  the  cerebro-spinal  ap- 
paratus were  abolished,  whilst  the  others  had  not  experienced  the 
least  change.     Voluntary  ejaculation  was  impossible,  because  the 


212  CAUSES    OF    SPERMATOEEHCEA. 

penis  had  lost  all  sensibility,  and  consequently,  all  its  influence  over 
the  seminal  vesicles.  This  confirms  what  I  have  already  stated  re- 
specting the  difficulty  of  ejaculation  caused  by  intoxication  or  nar- 
cotism. It  is  sufficiently  evident,  that  alcoholic  drinks,  &c.,  when 
the  stupor  is  perfect,  may  retard  ejaculation,  or  even  render  it  im- 
possible, although  erection  may  be  complete.  In  this  patient,  there 
was  constant  and  energetic  priapism,  which  was  not  accompanied  by 
any  lascivious  ideas,  because  it  was  produced  directly  by  the  accu- 
mulation of  semen  in  its  reservoirs,  without  any  sensation  being 
transmitted  to  the  encephalon,  at  least  during  the  waking  state.  But 
during  sleep,  all  the  senses  being  inactive,  as  well  as  the  cerebro- 
spinal system,  and  the  nerves  derived  from  it,  sensations  transmitted 
by  the  branches  of  the  trisplanchnic,  might  awaken  images  and  as- 
sociations of  ideas,  as  well  as  produce  from  time  to  time  lascivious 
dreams  and  nocturnal  pollutions — proving  that  these  phenomena  are 
directly  under  the  control  of  the  great  sympathetic. 

On  the  other  hand,  this  patient  never  had  diurnal  pollutions,  not- 
withstanding the  complete  paralysis  of  the  nerves  given  to  the  genital 
organs  by  the  spinal  cord ;  we  may  conclude,  therefore,  with  every 
show  of  reason,  that  involuntary  diurnal  pollutions  cannot  be  symp- 
tomatic of  atrophy  of  the  spinal  cord,  or  of  the  nerves  arising  from  it. 

I  do  not  imagine  that  the  same  thing  holds  good  as  regards  irrita- 
tion or  excitement  of  the  spinal  cord,  Avhich  may  be  transmitted  to 
the  genital  organs  by  the  nerves  which  are  distributed  to  them.  I 
believe  that  serious  seminal  discharges  may  arise  from  this  cause — 
founding  my  opinion  on  the  injurious  influence  produced  in  some 
cases  by  issues  or  cutaneous  eruptions  in  the  lumbar  region,  as  well 
as  by  the  manner  in  which  lying  on  the  back  produces  nocturnal 
pollutions,  and  the  incontrovertible  benefit  derived  in  some  cases  of 
spermatic  discharges,  from  douches  and  cold  applications  on  the  lower 
portion  of  the  spinal  column.  I  have,  however,  no  records  of  any 
case  in  which  this  spinal  irritation  was  sufficiently  marked  and  isolated 
to  merit  its  being  related  here. 


CHAPTER  X. 

CAUSES    OP"  SPERMATORRHEA. 

Congenital  Predisposition. 

The  causes  of  which  I  have  yet  to  speak  are  very  various,  and  for 
the  most  part,  sufficiently  obscure.  The  facts  which  I  shall  have  to 
relate  are  even  less  known  than  those  I  have  treated  of  hitherto. 
They  are  more  difficult  of  appreciation,  and  probably  they  present 


CONGENITAL    PREDISPOSITION.  213 

also  greater  interest.  They  refer,  in  fact,  to  unfortunates,  ^hose  fu- 
ture is  seriously  affected  by  causes  entirely  independent  of  their  con- 
duct, but  -which  weigh  down  all  their  lives  like  a  kind  of  fatality. 
They  differ  from  all  the  causes  I  have  hitherto  examined,  by  being 
inherent  in  the  organs  of  generation  themselves.  But  they  may  pre- 
sent themselves  under  very  different  aspects ;  they  may  arise  either 
from  vicious  conformation,  from  a  condition  of  original  debility,  from 
a  congenital  relaxation,  or  irritability  of  the  organs,  or  from  heredi- 
tary predisposition. 

In  examining  these  various  congenital  causes,  I  shall,  as  before, 
pass  from  the  more  evident  to  the  more  obscure  ;  and  I  shall  take 
this  opportunity  of  commenting  on  the  characters,  by  means  of  which 
we  can  sometimes  estimate,  with  some  degree  of  precision,  the  powers, 
so  unequal,  of  the  generative  organs.  This  is  of  considerable  import- 
ance in  the  study  and  treatment  of  involuntary  seminal  discharges. 

Sebaceous  Matter. 
CASE  LII. 

Natural  Phimosis — Frequent  nocturnal  pollutions  from  the  age  of  puberty 
— Abundant  and  fetid  sebaceous  secretion  beticeen  the  glnns  and  pre- 
puce—  Circumcision  at  the  age  of  twenty-three  followed  by  immediate 
relief. 

M.  B ,  aet.  twenty-three,  of  nervous  temperament,  having  enjoyed 

good  health  up  to  the  period  of  puberty,  from  that  time  presented  a  yellow 
and  leaden  appearance,  with  sunken  eyes,  forehead  covered  with  acne  punc- 
tata, and  timid  manners.  For  a  long  time  he  had  appeared  as  if  plunged 
into  deep  melancholy,  and  constantly  sought  solitude.  He  was  restless,  but 
was  unable  to  bear  fatigue.  Digestion  was  difficult,  and  his  intellect  dull. 
This  disorder  had  lasted  four  or  five  years,  but  had  increased  sensibly  during 

the  last  year  before  M.  B came  to  consult  me.     I  suspected  him  of  bad 

habits,  but  he  assured  me  that  he  had  escaped  them  from  want  of  desire,  and 
that  he  had  never  had  sexual  intercourse.  From  the  period  of  puberty,  how- 
ever, M.  B had  been  subject  to  nocturnal  pollutions,  the  frequency  and 

abundance  of  which  had  progressively  increased;  and  in  spite  of  the  meaas 
generally  recommended  in  such  cases,  pollutions  occurred  every  night,  and 
sometimes  two  or  three  times  during  the  night.  He  had  never  noticed  asca- 
rides  in  the  feces,  nor  experienced  itching  at  the  anus. 

I  was  uncertain  to  what  cause  to  attribute  these  pollutions,  when  on  exa- 
mining the  genital  organs,  I  noticed  that  the  opening  of  the  prepuce  was 
very  narrow,  and  that  abundance  of  sebaceous  matter  escaped.  Pressure  made 
from  behind  forwards  produced  the  discharge  of  a  large  quantity  of  matter  of 
milky  appearance  and  considerable  fetor.  I  concluded,  therefore,  that  the 
natural  phimosis,  by  preventing  the  discharge  of  the  sebaceous  secretion,  was 
the  cause  of  involuntary  discharges,  and  in  consequence  recommended  cir- 
cumcision, which  was  performed  immediately.  I  found  a  large  quantity  of 
sebaceous  matter  resembling  soft  cheese  in  color  and  consistence,  and  of  a 
very  disagreeable  smell,  covering  the  surface  of  the  glans,  and  especially  col- 
lected round  the  corona  glandis.  The  glans  itself  was  vividly  red,  almost 
14 


21-i  CAUSES    OF    SPEEMATOREHCEA. 

entirely  deprivccl  of  its  epithelium,  extremely  sensitive — the  least  friction 
causing  a  discharge  of  blood. 

From  this  moment,  M.  B passed  a  fortnight  at  a  time,  and  sometimes 

longer,  without  having  nocturnal  pollutions,  which  afterwards  only  arose 
from  spermatic  plethora.  A  rapid  change  took  place  in  his  health  and  habits, 
so  that  at  the  end  of  the  month  he  was  scarcely  recognizable. 

This  case  is  the  most  simple  and  perfect  of  the  kind  that  I  have 
met  with.  It  shows  clearly  enough,  that  natural  .phimosis  may  be 
sufficient  to  bring  on  pollutions,  for  the  patient  had  never  practised 
masturbation,  nor  had  sexual  intercourse.  It  was  evident  that  the 
prolonged  retention  of  the  sebaceous  matter  gave  it  an  acrid  and 
irritating  character — the  constitution  being  free  from  humoral  dispo- 
sition, or  cutaneous  affection.  On  the  other  hand,  the  genital  organs 
were  well  developed,  and  the  health  was  not  very  seriously  affected, 
so  that  excision  of  the  prepuce  produced  a  sudden  and  durable  effect. 
I  have  seen  many  analogous  cases,  but  in  these  the  effects  of  this 
mal-conformation  of  the  prepuce  in  causing  involuntary  discharges, 
were  not  so  marked,  because  other  causes  were  usually  superadded. 
Thus,  in  one  case  ascarides  were  present  at  the  same  time,  and  in 
many  others,  the  patients  had  practised  masturbation.  Masturbation 
in  such  cases  was  generally  excited  spontaneously,  and  it  is  likely 
enough  that  the  phimosis  should  contribute  to  this  result.  Irritation 
of  the  glans  by  sebaceous  matter  excites  importunate  erections  and 
titillations,  which  attract  the  attention  of  children  to  the  parts,  and 
induce  handling  and  friction.  We  may,  therefore,  attribute  the 
spontaneous  occurrence  of  masturbation  in  young  children  who  are 
thus  formed,  to  the  too  long  continued  presence  of  the  sebaceous 
matter  between  the  glans  and  prepuce.  ISIumerous  examples  have 
left  me  no  doubt  on  this  subject. 

The  following  case,  which  is  still  under  ray  care,  presents  remark- 
able circumstances. 

CASE  LIII. 

Natural  phimosis — Erections  at  the  age  of  eight — Attempt  at  coitus  at  nine 
—  Vesical  catarrh — Diurnal  pollutions — Parajileyia,  &c. 

A  peasant  consulted  me  for  his  son,  ast.  fifteen,  who,  for  two  years  had 
experienced  a  constantly  increa.sing  paralysis  of  the  lower  extremities.  On 
his  sides  and  loins  were  murks  of  numerous  issues  which  had  been  tried 
during  two  years.  Large  excoriations  had  formed  on  the  sacrum  and  tro- 
chanters. 

On  examining  the  genital  organs,  I  noticed  that  the  prepuce  was  very  nar- 
row ;  and  on  pressing  it  to  get  rid  of  the  sebaceous  matter  which  presented 
at  its  orifice,  the  penis  became  erect.  I  learnt  from  the  parents  that  this 
boy  had  erections  at  the  age  of  eight;  and  that  at  nine  years  of  age,  he  bad 
been  found  attempting  coitus.  The  boy  himself  admitted  that  the  itching 
with  which  he  was  tormented  led  him  to  rub  the  genital  organs,  and  thus 
induced  manoeuvres  which  he  had  since  continued. 


CONGENITAL    PKEDISPOSITION.  215 

The  first  symptom  that  presented  itself  was  frequent  desire  of  micturition, 
and  this  was  followed  in  about  a  year  by  complete  incontinence  of  urine. 
In  the  course  of  the  second  year,  the  patient's  legs  grew  weak;  he  lost  his 
intellectual  capacity  ;  digestion  became  disordered  ;  diarrhoea  came  on  ;  and 
the  discharge  of  urine  and  feces  caused  excoriation  of  the  skin.  Salt  and 
aromatic  baths,  tonics,  excitants,  &c.,  had  been  just  as  useless  as  issues. 
The  cause  of  the  disease  was  unsuspected. 

Masturbation  had  become  very  rare,  but  the  urine  was  thick,  muddy,  and 
very  fetid — so  much  mucus  was  passed,  that  I  was  unable  to  make  sure  of 
its  containing  semen — but  the  patient  had  constant  pollutions  at  stool. 

I  first  performed  ablation  of  the  prepuce ;  and  eight  days  after,  I  caute- 
rized the  bladder  and  surface  of  the  prostate.  A  month  afterwards,  the 
urine  was  perfectly  transparent,  and  presented  a  healthy  appearance ;  it  was 
no  longer  passed  involuntarily.  Sensibility  of  the  skin  of  the  lower  extremi- 
ties had  returned.  Improvement  was  here  arrested,  however,  and  I  lost  sight 
of  the  patient. 

This  patient  had  never  been  subjected  to  the  influence  of  bad  ex- 
ample, and  had  always  been  well  cared  for.  He  explainly  clearly 
how  he  was  led  to  practise  masturbation  ;  and  circumstances  gave 
an  appearance  of  truth  to  his  recital.  It  is,  then,  to  the  irritating 
action  of  the  sebaceous  matter  that  we  must  attribute  his  unfortu- 
nate condition. 

Natural  Phimosis. — In  the  venereal  wards  at  the  hospital  St.  Eloi, 
numerous  soldiers  present  themselves  yearly  for  attacks  of  balanitis, 
which  they  consider  bastard  clap.  Certainly,  in  many  of  these  cases, 
the  discharge  arises  from  the  action  of  blennorrhagic  virus  ;  blennor- 
rhagia  is  present  at  the  same  time,  and  both  discharges  have  super- 
vened on  impure  connection.  But  in  many  other  cases,  the  inflam- 
raation  arises  from  the  acridness  of  the  sebaceous  matter,  caused  by 
its  too  long  retention  between  the  glans  and  prepuce.  Such  cases  of 
balanitis  are  rarely  observed,  except  in  persons  whose  prepuce  is  too 
contracted  to  permit  the  glans  being  uncovered.  Sometimes  they 
occur  as  the  result  of  drinking  or  of  fatigue,  without  any  connection 
having  taken  place.  These  inflammations  rapidly  disappear  when 
the  prepuce  has  been  removed,  or  even  when  the  parts  are  kept  con- 
stantly washed — leaving  no  doubt  as  to  their  true  cause. 

In  many  cases,  when  I  have  practised  circumcision  for  congenital 
phimosis,  I  have  found  the  glans  and  prepuce  adherent  to  a  greater 
or  less  extent,  especially  in  the  neighborhood  of  the  corona  glandis, 
around  which  the  sebaceous  matter  accumulates  most  readily,  and 
whence  it  is  most  diflicult  of  removal.  In  some  cases  I  have  seen 
these  adhesions  extend  over  half  the  extent  of  the  glans,  and  they 
were  always  situated  in  the  parts  furthest  from  the  preputial  orifice. 
In  a  few  cases,  I  have  only  found  the  point  of  the  glans  free  from 
adhesions.  Such  adhesions  could  only  be  established  by  the  destruc- 
tion of  the  mucous  linings  of  the  parts — these  linings  never  becoming 
adherent  so  long  as  they  retain  their  mucous  structure.     The  inflam- 


216  CAUSES    OF    SPERMATOERHCEA. 

mation  of  the  surfaces  of  the  glans  and  prepuce  must  therefore  have 
been  sufficiently  severe  to  cause  superficial  ulceration. 

I  have  frequently  seen  the  surface  of  the  glans  excoriated,  with 
elevated  papillge  and  drops  of  blood  exuding  from  them ;  at  other 
times  I  have  found  the  glans  deprived  of  epithelium  with  excavated 
ulcers.  In  such  cases,  the  corresponding  surface  of  the  prepuce  was 
always  more  or  less  excoriated,  or  ulcerated  also  ;  and  these  excoria- 
tions were  often  accompanied  with  inflammatory  swelling  of  the  lym- 
phatic glands  in  the  groin.  These  ulcerations  have  been  confounded 
with  chancres  ;  but  their  edges  are  thinner,  and  they  are  less  deeply 
excavated ;  the  neighboring  parts,  too,  are  covered  with  a  layer  of 
sebaceous  matter  of  caseous  aspect  and  fetid  smell.  Such  ulcerations 
disappear  after  the  removal  of  the  prepuce,  their  appearance  be- 
coming changed  even  in  twenty-four  hours.  Fomentations  and 
cleanliness  do  all  the  rest. 

Such  is  the  condition  which  the  parts  present  in  cases  of  recent 
balanitis  ;  and  these  are  the  inflammations  and  ulcerations  that  cause 
more  or  less  extensive  adhesions  of  the  prepuce  to  the  glans;  such 
adhesions  are  generally  cellular,  but  sometimes  fibrous  or  even  carti- 
laginous, according  to  the  severity  and  frequent  repetition  of  the 
inflammation. 

Various  degrees  of  induration  also  result,  according  to  the  intensity, 
the  duration,  and  the  frequency  of  the  phlogosis.  Thus,  I  have  often 
found  the  mucous  membrane  hardened,  thickened,  and  covered  with 
numerous  papilloe,  sometimes  fibrous  or  even  cartilaginous,  with  three 
times  its  natural  thickness.  I  have  also  met  with  cases  in  which  the 
prepuce  has  become  cancerous.  I  have  operated  in  several  cases  of 
cancer  of  the  penis,  too,  which  certainly  arose  from  no  other  cause. 
The  patients  were  generally  peasants  between  fifty  and  sixty  years 
of  age,  who  had  never  known  other  than  their  wives,  but  who  had 
frequently  suffered  from  balanitis,  attended  by  abundant  discharge, 
swelling  of  the  prepuce,  and  excoriation  of  its  opening,  which  was  so 
contracted  as  to  prevent  the  passage  of  the  glans.  I  have  seen  one 
case  also,  in  which  balanitis,  irritated  by  a  forced  march,  and  the 
abuse  of  alcoholic  stimulants,  passed  into  gangrene,  by  which  the 
greater  part  of  the  glans  was  destroyed. 

Such  have  been  the  accidents  which  I  have  observed  in  those 
whose  prepuce  was  too  narrow  to  permit  the  glans  being  uncovered  ; 
accidents  which  I  can  only  attribute  to  the  long  retention  of  the 
sebaceous  matter  in  a  kind  of  cul-de-sac,  into  which  a  certain  quan- 
tity of  urine  passes  every  time  the  patient  makes  water. 

But  natural  phimosis  is  not  the  only  cause  of  the  injurious  effects 
produced  on  the  genital  organs  by  the  sebaceous  matter  ;  as  the  fol- 
lowing case  will  show. 


CONGENITAL    PKEDISPOSITION.  217 


CASE  LIV. 

Yery  long  'prepuce — Badly  developed  genital  organs —  Childhood  delicate — 
Incontinence  of  tirine — Sebaceous  discharge  from  the  orifice  of  the  pre- 
puce  at  the  age  of  ten — Nocturnal  pollutions  increasing  in  frequency — 
Hypochondriasis — Loss  of  memory  and  failure  of  intellect — Constipation 
— Diurnal  pollutions — Constant  application  of  lotions  attended  by  relief 
—  Circumcision  at  the  age  of  twenty-eighty  followed  by  cure. 

M.  J.  B ,  of  Amsterdam,  of  delicate  constitution  and  lymphatic  tem- 
perament, was  subject  during  childhood  to  incontinence  of  urine,  and  always 
suffered  from  frequent  desire  to  make  water.  About  the  age  of  ten,  a 
whitish  matter  formed,  and  was  discharged  from  underneath  the  prepuce ; 
after  which  erections  occurred,  and  were  soon  followed  by  emissions  :  a  very 
disagreeable  smell  accompanied  the  preputial  discharge.  The  seminal  dis- 
charges increased  as  the  patient's  passions  were  roused,  and  he  grew  sad, 
silent,  discontented,  and  constantly  occupied  with  the  origin  of  his  disoi'der. 
He  imagined  that  the  whitish  discharges  arose  from  venereal  disease,  although 
he  had  never  had  connection.  His  health  became  much  disordered,  and  at 
the  age  of  nineteen  he  mentioned  his  condition  to  his  medical  attendant. 
Lotions  were  prescribed,  which  removed  the  sebaceous  matter  and  produced 
considerable  improvement  in  the  patient's  health. 

M.  B 's  bowels  became  constipated,  however,  and  he  perceived  that 

be  passed  semen  while  at  stool,  in  consequence  of  the  efforts  necessary. 
The  nocturnal  pollutions  diminished  in  frequency,  but  still  occurred  occa- 
sionally. 

When  M.  J.  B consulted  me  in  November,  1836,  he  presented  the 

following  condition  :  small  stature,  limbs  slight  and  chest  narrow ;  skin 
fair  and  soft ;  hair  white  and  thin  ;  face  very  pale ;  manner  timid  and  em- 
barrassed ',  hesitation ;  habit  of  stammering,  arising  from  disorder  in  the  in- 
tellect and  loss  of  the  memory ;  genital  organs  remarkably  small ;  penis 
small  and  short,  hidden  among  long  scanty  white  hairs ;  prepuce  very  long, 
forming  numerous  folds  in  front  of  the  glans ;  surface  of  the  glans  covered 
by  a  thin  layer  of  sebaceous  matter,  notwithstanding  the  utmost  cleanliness 
on  the  part  of  the  patient ;  scrotum  compressed  and  much  folded,  containing 
only  the  right  testicle,  about  the  size  of  an  almond,  the  left  being  felt  in  the 
inguinal  canal  attached  to  a  portion  of  omentum.  No  spinal  curvature 
(which  the  patient  had  feared),  his  mistake  arising  from  the  projection  of 
the  hips  and  pelvis,  which  resembled  those  of  a  woman. 

I  removed  the  prepuce  entirely  in  order  to  put  an  end  to  the  influence  of 
the  sebaceous  matter  on  the  glans ;  catheterism  not  giving  much  pain,  I  did 
not  consider  cauterization  necessary ;  but  in  order  to  give  tone  to  the 
organs  I  left  a  catheter  in  the  bladder  for  an  hour  or  two  at  a  time  once  a 
week,  and  ordered  the  free  use  of  cold  douches  to  combat  the  constipation. 
The  patient's  temperament  being  exceedingly  lymphatic,  I  afterwards  pre- 
scribed three  or  four  aromatic  baths  weekly,  with  the  habitual  use  of  Spa 
water. 

These  means  lengthened  the  periods  between  the  nocturnal  pollutions, 
diminished  the  constipation,  and  lessened  the  involuntary  discharges  that 
took  place  when  the  efforts  at  stool  were  considerable.  Acupuncture  of 
the  perineum  and  prostate  produced  more  rapid  and  decided  effects.     After 


218  CAUSES    OF    SPERMATORRHCBA. 

this  had  been  practised,  sixteen  days  were  passed  without  nocturnal  pollu- 
tions, and  the  efforts  at  stool  did  not  cause  any  seminal  discharge.  By  de- 
grees the  patient's  face  became  more  healthy-looking  and  animated ;  his 
strength  and  energy  returned ;  his  character  regained  its  boldness  and 
gayety  ;  erections  became  frequent  and  energetic  ;  and  his  health  altogether 

having  become  as  good   as  could   be  desired,  M.  B returned  to  his 

home. 

Six  months  afterwards  I  accidentally  met  M.  B in  Paris;  he  frequented 

theatres  and  amusements,  and  went  into  society ;  indeed  his  character  was 
quite  changed. 

I  have  seen  few  men  so  badly  developed  as  M.  B .     It  was 

certainly  to  the  poor  development  of  the  penis  that  the  length  of  the 
prepuce  was  attributable — the  skin  of  the  penis  not  being  longer 
than  natural,  though  it  proved  exuberant  when  compared  with  the 
parts  it  was  intended  to  cover.  The  scrotum  presented  the  same 
appearance  as  the  prepuce,  and  from  the  same  cause.  It  was  re- 
tracted towards  the  pubes,  and  formed  numerous  and  deep  folds — 
the  testicles  not  being  more  developed  than  in  a  child  of  eight  years ; 
the  left  one,  too,  was  entangled  in  the  corresponding  inguinal  canal. 
This  slow  descent  of  the  testicles  is  a  sign  of  weakness,  which  cor- 
responded with  their  small  dimensions. 

The  incontinence  of  urine  to  which  M.  B was  long  subject, 

announced  debility  of  the  urinary  passages,  from  which  no  opinion 
could  be  drawn  in  favor  of  the  power  of  the  spermatic.  The  con- 
nection between  the  two  systems  showed  itself  to  the  last — a  frequent 
desire  to  micturate  accompanying  the  seminal  discharges. 

The  fancied  deformity  of  the  spinal  column  was  merely  a  projec- 
tion of  the  hips,  which  gave  the  form  of  the  female  sex — a  conforma- 
tion which  I  have  frequently  observed  with  extreme  weakness  of  the 

genital  organs.     I  should  notice  that  M.  B was  born  and  brought 

up  in  Holland ;  that  his  childhood  was  delicate,  and  that  his  tempe- 
rament was  very  decidedly  lymphatic. 

It  may  be  readily  conceived,  that  with  these  predispositions  M. 

B escaped  all  bad  habits,  and  that  he  continued  continent ;  yet 

at  ten  years  of  age  he  was  subject  to  frequent  nocturnal  pollutions. 
How  was  this  ?  The  pollutions  seem  to  have  arisen  from  the  stimu- 
lating influence  of  the  sebaceous  matter  collected  between  the  pre- 
puce and  glans.  The  improvement  derived  from  the  use  of  lotions 
at  the  age  of  nineteen  corroborates  this  opinion.  These  means, 
however,  only  gave  momentary  relief;  circumcision  at  the  age  of 
twenty- eight,  did  not  suffice  alone  to  bring  about  perfect  re-establish- 
ment, in  consequence  of  the  debility  of  the  genital  organs  and  the 
obstinate  constipation  which  had  excited  diurnal  pollutions,  added  to 
the  difficulty  of  breaking  a  habit  which  had  continued  eighteen  years. 
Aromatic  baths,  Spa  water,  frequent  douches,  and  lastly,  acupuncture, 
were  employed  to  combat  these  complications.  The  remarkable 
effect  of  the  last  remedy  shows  that  habit  had  much  to  do  with  keep- 
ing up  the  pollutions. 


CONGENITAL    PREDISPOSITION.  219 


CASE  LV. 

Very  long  prepuce — Badly  develo2)ed  erectile  tissues — Ahinidant  secretion 
of  sebaceous  matter — Semincd  emissions  induced  hy  horse  exercise,  and 
afterwards  hy  incomplete  intercourse — Marriage  unconsummated  during 
Jive  years — Diurnal  pollutions — Circumcision  followed  hy  rapid  cure. 

M.  C ,  of  robust  constitution,  born  in  Switzerland,  the  son  of  healthy 

and  strict  parents,  was  early  imbued  with  rigid  moral  and  religious  princi- 
ples. At  the  age  of  eighteen  he  experienced  for  the  first  time,  while  on 
horseback,  an  abundant  seminal  emission,  and  he  afterwards  frequently  had 
recourse  to  the  same  means  to  excite  a  return  of  the  voluptuous  sensations, 
against  which  he  had  never  been  warned.  After  a  time,  too,  he  found  a 
means  of  procuring  them  by  other  manoeuvres.  Still  he  did  not  practise 
these  abu.ses  very  often,  often  abstaining  for  a  month  or  two  at  a  time; 
and  consequently  his  health  was  uninjured.  At  the  age  of  twenty-five, 
having  never  had  sexual  intercourse,  he  married.     Four  years  afterwards, 

being  disappointed  at  not  having  children,  M.  C consulted  his  medical 

attendant,  who,  by  dint  of  questioning,  discovered  that  the  marriage  had 
never  been  properly  consummated.  Frequent  and  abundant  emissions  had 
indeed  taken  place,  even  with  much  facility ;  but  they  had  been  produced 
by  simple  pressure,  or  at  most,  by  slight  external  friction.     Unfortunately 

for   31.  C his  erections,  which   had  been   very  energetic  at  first,  had 

progressively  diminished,  so  that  he  was  now  quite  unable  to  profit  by  the 
instructions  he  received. 

Ferruginous  preparations,  friction  on  the  loins,  cold  injections  into  the 
urethra,  and  various  tonics  were  employed,  and  did  more  harm  than  good. 

M.  C was,  therefore,  sent  to  consult  me  in  July,  1837,  five  years  after 

his  marriage. 

He  was  then  thirty  years  of  age,  tall,  strongly  built,  and  apparently  in 
excellent  health ;  he  experienced,  however,  a  degree  of  debility  in  his  hands 
and  legs;  all  his  functions,  with  the  exception  of  those  belonging  to  gene- 
ration, were  well  performed.  The  penis  was  remarkably  small;  the  prepuce, 
on  the  contrary,  much  longer  than  the  erectile  tissues,  formed  numerous 
folds  in  front  of  the  glans,  and  was  lined  with  a  large  quantity  of  sebaceous 
matter;  several  thick  layers  of  it  were  also  accumulated  on  the  surface  of 
the  glans,  which  was  much  injected  and  extremely  sensitive.  The  urine 
always  contained  a  more  or  less  abundant  flocculent  deposit,  in  which  I 
invariably  discovered  spermatozoa. 

I  immediately  performed  excision  of  the  prepuce,  and  a  few  days  after- 
wards, the  urine  became  transparent,  and  the  erections  reappeared — weak 
at  first,  but  soon  acquiring  energy.  The  object  of  marriage  was  at  length 
properly  fulfilled. 

I  have  recently  learnt  that  M.  C is  about  to  become  a  father. 

The  abuses  to  which  this  patient  was  impelled  spontaneously  were 
too  rarely  practised  to  have  had  any  power  in  producing  this  singular 
affection ;  besides,  immediately  after  his  marriage  his  erections  were 
frequent  and  active  enough,  but  ejaculation  took  place  too  rapidly: 
by  considering  this  in  connection  with  the  fact  of  seminal  emissions 


220  CAUSES    OF    SPERMATORRHCEA. 

havlnty  been  excited  by  horse  exercise,  we  must  arrive  at  the  opi- 
nion that  the  penis  was  excessively  sensitive.  This  could  not  be 
attributed  to  predominance  of  the  erectile  tissues,  these  being,  on  the 
contrary,  remarkable  for  their  paucity ;  some  irritating  cause  must, 
therefore,  have  excited  and  kept  up  the  abnormal  sensibility  of  the 
glans,  and  this  irritation  could  only  arise  from  the  sebaceous  matter 
on  its  surface  being  altered  by  too  long  retention.  This  opinion  is 
strengthened  by  the  simple  excision  of  the  prepuce  sufficing  to  arrest 
the  diurnal  pollutions,  and  to  bring  about  complete  performance  of 
the  genital  functions. 

Exuberant  Prepuce. — In  the  cases  I  have  just  related  the  genital 
organs  were  remarkable  for  their  small  development.  The  corpora 
cavernosa  were  small  and  short,  and  were  surmounted  by  a  very 
small  glans,  the  whole  forming  a  kind  of  vermiform  appendage  in 
front  of  the  pubes,  composed  almost  entirely  of  corrugated  skin,  and 
nearly  hidden  among  long  and  scarce  hairs.  The  scrotum  presented 
an  analogous  disposition  ;  it  was  retracted  towards  the  pubes,  and 
formed  numerous  and  deep  folds.  The  testicles  were  remarkably 
small,  and  in  the  54th  case,  one  of  them  had  not  passed  the  inguinal 
canal.  The  extreme  length  of  the  prepuce,  as  well  as  its  numerous 
folds,  must  be  attributed  to  the  small  development  of  the  erectile 
tissues ;  and  the  numerous  and  deep  folds  of  the  scrotum  arose  from 
the  smallness  of  the  testicles.  These  circumstances  are,  therefore, 
frequently  met  with  together,  and  very  often  congenital  hernia,  vari- 
cocele, or  great  width  of  the  pelvis,  with  the  rounded  form  of  the 
female,  are  superadded. 

All  the  patients  of  this  kind  that  I  have  met  with  have  possessed 
a  delicate  constitution^  and  had  passed  a  sickly  childhood  ;  they  were 
generally,  too,  of  nervous  or  lymphatic  temperament.  Most  of  them 
had  received  a  very  strict  education. 

Still,  these  patients  have  generally  suffered  from  nocturnal  pollu- 
tion arising,  without  any  kind  of  excitement,  about  the  ages  of  ten 
or  twelve ;  or  they  have  been  led  spontaneously  to  commit  serious 
abuses  before  the  age  of  puberty  (one  of  my  patients  committed 
venereal  excesses  at  a  very  early  age) ;  and  they  all  fell  promptly 
into  a  state  of  complete  impotence,  arising  from  diurnal  pollutions. 

The  premature  erections  from  which  these  patients  suffered  are 
certainly  not  attributable  to  the  rudimentary  condition  of  the  genital 
organs,  nor  to  their  sickly  infancy ;  the  circumstances  in  which 
they  were  placed,  too,  had  no  influence  in  causing  abuse ;  and  the 
patients  did  not  suffer  from  ascarides.  The  premature  activity, 
therefore,  arose  from  simple  local  excitement  of  the  penis ;  and  this 
was  not  produced  by  the  presence  of  semen,  because  in  many  cases 
the  testicles  bad  not  begun  to  secrete.  The  accumulation  of  the 
sebaceous  matter  around  the  glans,  is  the  only  sufficient  explanation 
of  this  habitual  abnormal  irritation ;  and  this  opinion  is  strengthened 
by  the  more  or  less  frequent  occurrence  of  discharges,  and  by  the 
habitual  excoriation  of  the  opening  of  the  prepuce  ;  by  the  frequent 


CONGENITAL    PEEDISPOSITION.  221 

attacks  of  inflammation,  by  the  tenderness  of  the  glans,  and  the 
injection  of  its  surface.  The  remarkable  effects  produced  by  clean- 
liness, and  by  excision  of  the  prepuce,  leave  no  doubt  on  this 
subject. 

Such  persons,  then,  as  have  the  prepuce  very  long  and  folded  in 
front  of  the  glans,  are  exposed  quite  as  much  as  those  who  have  a 
natural  phimosis  to  all  the  inconveniences  which  arise  from  the  col- 
lection and  putrefaction  of  the  sebaceous  matter  ;  and  the  irritation 
in  both  cases  extends  to  the  urinary  and  spermatic  organs. 

There  is,  however,  one  point  of  difference  between  natural  phi- 
mosis and  exuberant  prepuce,  which  it  is  of  importance  to  notice. 
Excessive  length  of  the  prepuce  generally  depends  on  paucity  of 
erectile  tissues,  and  is  frequently  coincident  with  rudimentary  testi- 
cles ;  it  results,  therefore,  that  in  this  case  the  irritation  acts  on  weak 
and  mal-formed  organs,  which  are  easily  affected  by  the  abuses  or 
excesses  which  it  excites  :  the  involuntary  seminal  discharges  that 
occur  in  these  cases  are,  therefore,  very  difficult  of  cure.  In  cases 
of  natural  phimosis,  on  the  other  hand,  circumcision  alone  generally 
suffices  to  bring  about  a  cure,  because  the  narrowness  of  the  pre- 
puce does  not,  like  its  exuberance,  accompany  a  small  development 
of  the  genital  organs. 

In  cases  of  exuberant  prepuce,  things  are  not  so  simple,  for  it  does 
not  suffice  to  remove  the  part,  or  even  to  relieve  the  irritation  of  the 
urethra  and  bladder ;  congenital  debility  of  the  genito-urinary 
organs  remains,  which  it  is  often  very  difficult  to  remove  by  tonics, 
on  account  of  the  susceptibility  of  the  tissues  arising  from  their  long 
irritation ;  this  debility,  too,  arises  from  the  primary  organization  of 
the  parts,  and  is  consequently  difficult  to  cure  entirely.  Such  pa- 
tients seldom  possess  extraordinary  vigor. 

I  have  still  to  speak  of  cases  in  which  there  is  an  excessive  or 
vitiated  sebaceous  secretion,  although  the  prepuce  may  be  of  proper 
form. 

Abundant  and  vitiated  secretions  of  sebaceous  matter. — In  many 
cases  the  sebaceous  matter  is  not  confined  by  a  too  narrow  or  too 
long  prepuce ;  it  seems  rather  to  be  reproduced  very  rapidly,  or  its 
properties  to  be  modified  by  some  pathological  condition.  The 
mucous  follicles  of  the  glans  and  prepuce  are  much  more  developed 
and  more  active  in  some  individuals  than  in  others,  and  furnish  ha- 
bitually a  much  greater  quantity  of  sebaceous  secretion.  This  parti- 
cular disposition  shows  itself  early,  and  continues  during  the  whole 
life;  it  is  a  permanent  condition,  and  its  effects  may  show  themselves 
at  any  moment.  Extreme  cleanliness  might  perhaps  prevent  any  in- 
convenience being  felt ;  but  as  the  gravity  of  the  consequences  that 
may  result  is  not  suspected,  and  as  besides,  this  peculiar  predisposi- 
tion cannot  be  foreseen  by  parents,  there  is  no  motive  for  causing 
children  to  practise  ablution,  or  friction-  of  the  parts — which  indeed, 
by  drawing  their  attention,  might  be  dangerous.  These  cases  are 
not  practised  then  at  the  period  of  puberty ;  yet  it  is  then  especially 


222  CAUSES    OF    SPERMATORRHCBA. 

that  they  are  requisite  in  cases  where  the  sebaceous  secretion  is  dis- 
ordered, on  account  of  that  orgasm  which  at  that  age  seizes  the  whole 
of  the  genital  apparatus.  I  am  thoroughly  convinced  that  this  par- 
ticular circumstance  is  the  direct  cause  of  numbers  of  cases  of  in- 
voluntary discharges,  as  well  as  very  frequently  of  the  spontaneous 
abuses  of  which  young  lads  are  the  subjects. 

There  are  other  cases  in  which  the  secretion  is  increased  or  altered 
by  a  morbid  condition,  which  is  ordinarily  intermittent,  arising  almost 
always  from  a  special  disposition  of  the  economy,  particularly  from 
cutaneous  diseases,  often  enough  hereditary  ones.  The  constitution 
of  such  patients  is  ordinarily  weak  and  delicate  ;  their  childhood, 
sickly.  The  first  symptoms  of  these  cutaneous  affections  which 
generally  sooner  or  later  attack  the  mucous  membranes,  are  mostly 
experienced  in  the  head  or  face.  The  children  are  subject  to  ring- 
worms, acne,  tetters,  abscesses  in  the  neck,  alternately  with  attacks 
of  ophthalmia,  otorrhoea,  coryza,  angina,  &c.  At  the  approach  of 
puberty,  these  weakly  constitutions  generally  improve,  and  seem 
about  to  become  hardy  ;  but  the  revolution  effected  by  that  important 
crisis  has  not  always  the  durable  and  salutary  effect  on  the  constitu- 
tion that  could  be  desired.  The  genital  organs  become  the  centre, 
and  attract  the  congestion  which  formerly  acted  chiefly  towards  the 
head  ;  and  hence  cutaneous  eruptions  occur  in  the  neighborhood  of 
the  anus,  in  the  perineum,  on  the  interior  of  the  thighs,  or  the 
scrotum,  at  the  base  of  the  penis,  and  more  than  all,  on  the  prepuce 
— bringing  the  most  unfortunate  consequences.  Whatever  may  be 
the  species  of  these  eruptions,  however  unimportant  they  may  ap- 
pear, it  is  of  the  utmost  consequence  to  pay  attention  to  them  when 
they  attack  the  prepuce  or  glans.^  From  them  arise  frequent  ba- 
lanitis, more  or  less  abundant,  and  acrid  sebaceous  discharge,  ex- 
coriations, herpes,  erysipelatous  redness  of  the  prepuce  and  glans, 
frequent  attacks  of  urethritis,  often  as  severe  as  virulent  clap,  and 
almost  always  more  difficult  of  removal,  frequently  also  giving  rise 
to  serious  errors  of  treatment.  This  irritation,  too,  sometimes  sud- 
denly attacks  parts  at  a  considerable  distance  from  the  orifice  of  the 
excretory  canal ;  hence  the  sudden  appearance  of  pain  in  the  peri- 
neum, or  neck  of  the  bladder ;  hence  the  painful  swelling  of  the  vasa 
deferentia  and  testicles  ;  hence  also  the  no  less  sudden  disappearance 
of  these  symptoms,  on  the  unexpected  appearance  of  inflammatory 
disorder  on  some  other  part  of  the  body. 

It  is  easy  to  conceive  that  these  irritations  may  provoke  abuses  or 
temporary  excesses,  as  well  as  more  or  less  serious  occasional  semi- 
nal discharges  ;  but  as  these  are  not  merely  nocturnal  pollutions, 
and  as  diurnal  ones  are  more  common,  more  serious,  and  very  dif- 
ficult of  discovery  by  the  patients — their  existence  is  seldom  sus- 
pected ;  so  that  they  do  not  know  how  to  account  for  the  periodical 

*  1  See  Chapter  V. 


CONGENITAL    PEEDISPOSITIOX.  223 

derangement  experienced  in  their  health  precisely  at  the  times  when 
they  are  not  troubled  with  apparent  disorder.  Their  friends  under- 
stand still  less  the  frequent  and  sudden  changes  of  character  they 
experience — the  alternations  of  gayety  and  hypochondriacism,  of  ac- 
tivity and  torpor.  Such  patients  are,  therefore,  very  often  regarded 
as  maniacs  ;  their  peevish  restlessness,  and  strange  paroxysms,  are 
attributed  to  wrong-headedness,  to  attempts  at  originality,  or  to  some 
other  equally  erroneous  explanation. 

After  a  time  diurnal  pollutions  occur  almost  constantly ;  and  now 
there  are  only  slight  remissions  in  the  symptoms  ;  the  health  remains 
imperfect,  and  the  paroxysms  occur  more  and  more  frequently  ;  at 
last  matters  grow  still  worse,  and  the  patient's  disorder  becomes 
constant. 

Both  the  patients  and  their  medical  attendants  are  led  astray  during 
the  most  severe  periods  of  the  disease,  by  the  diminution  or  entire 
cessation  of  the  nocturnal  pollutions ;  diurnal  discharges,  whose 
effects  are  much  more  serious,  take  their  place  ;  and  this  is  why,  on 
the  entire  cessation  of  nocturnal  pollutions,  the  disorder  becomes 
permanent,  and  complete  impotence  is  often  established.  Lessening 
of  the  nocturnal  pollutions  is  not  likely  to  lead  the  patients  to  suspect 
the  true  cause  of  their  disorder ;  they  imagine  themselves  the  victims 
of  a  syphilitic  affection,  founding  their  opinions  on  the  discharge  and 
excoriations  that  occur  in  the  neighborhood  of  the  glans  and  pre- 
puce, or  on  the  attacks  of  urethritis  to  which  they  are  subject.  I 
have  met  with  many  patients  who  had  spent  a  considerable  portion 
of  their  lives  under  courses  of  mercurial  treatment,  which  had  been 
repeated  over  and  over  again,  because  intercourse  scarcely  ever  took 
place  without  producing  excoriations ;  these  they  fancied  were 
chancres,  however  little  cause  there  might  have  been  to  suspect 
syphilitic  contagion.  In  such  patients,  too,  the  mucous  membrane  of 
the  urethra  becomes  altered  in  structure,  so  that  they  are  more  and 
more  exposed  to  urethral  discharges  from  very  slight  causes  ;  and 
the  repetition  of  such  discharges  confirms  their  belief  in  a  syphilitic 
taint. 

In  these  cases  cauterization  is  the  most  powerful  means  we  can 
employ.  Still  it  is  necessary,  after  considerably  modifying  the  con- 
dition of  the  urethral  mucous  membrane,  not  to  neglect  acting  on  the 
skin  and  on  the  whole  economy  by  means  of  the  sulphuretted  baths. 
It  is  wiser  also  to  perform  circumcision,  than  to  trust  to  the  patient's 
cleanliness,  in  order  to  guard  against  the  inconveniences  arising 
from  superabundant  secretion  of  the  mucous  follicles  of  the  pre- 
puce and  glans,  and  to  remove  the  parts  beyond  the  possibility  of 
further  irritation. 

I  have  spoken  several  times  of  the  influence  exercised  by  excre- 
tory canals  on  the  glands  that  supply  them  ;  on  comparing  the  glans 
penis  with  other  openings  to  excretory  ducts,  we  see  that  it  alone 
possesses  an  extensively  developed  erectile  and  nervous  tissue.  It 
is  true  the  nipple  presents  something  similar,  and  its  influence  over 


22-i  CAUSES    OF    SPEEMATOREHCEA. 

the  lacteal  secretion  is  well  known ;  but  there  is  vast  difference  be- 
tween the  vessels  and  nerves  of  the  nipple  and  those  of  the  glans 
penis.  In  the  glans  everything  seems  arranged  to  increase  the  ex- 
quisite sensibility  of  the  surface.  Is  it  to  be  wondered  at,  then,  that 
the  functions  of  the  seminal  vesicles  and  testicles  are  much  influ- 
enced by  every  action  on  so  impressionable  a  surface  ?  and  that  the 
accumulation  of  sebaceous  matter  provokes  importunate  erections 
before  puberty,  and  abuses  or  precocious  excesses,  in  persons  who 
would  seem  to  be  out  of  danger  of  them,  on  account  of  the  small  de- 
velopment of  their  genital  organs  ? 

The  divisions  under  which  I  have  treated  this  subject  are  intended 
to  show  that  the  irritating  action  of  the  sebaceous  matter  may  arise 
either  from  its  too  long  retention,  from  a  local  affection,  or  from  a 
general  disposition.  In  the  first  case  excision  of  the  perpuce  is  in- 
dispensable, and  when  there  is  simply  a  natural  phimosis,  this  is  gene- 
rally sufficient.  But  when  the  prepuce  is  excessively  long,  after  its 
removal,  and  even  after  cauterization  of  the  prostatic  surface,  we 
have  still  to  combat  the  natural  debility  of  the  organs — a  debility 
sufficiently  evident  by  the  exuberance  of  the  skin  in  front  of  the  ru- 
dimentary erectile  tissues.  In  cases  of  superabundant  secretion  of 
sebaceous  matter,  of  herpes  preputialis,  or  other  skin  affections, 
having  a  tendency  to  fix  themselves  on  the  prepuce,  it  is  more  pru- 
dent to  circumcise  the  patient  than  to  trust  to  the  most  careful  clean- 
liness ;  there  is  no  comparison  between  this  trifling  operation  and 
the  importance  of  the  involuntary  discharges  which  may  return  with 
a  return  of  the  preputial  irritation,  even  if  once  relieved  by  the  use 
of  sulphuretted  waters  or  other  means.  Indeed,  after  having  long 
and  seriously  reflected  on  the  numerous  cases  that  have  come  under 
my  notice,  I  have  arrived  at  the  opinion,  that  the  discontinuance 
of  the  practice  of  circumcising  children  is  to  be  regretted  ;  the  ope- 
ration is,  without  doubt,  unnecessary  in  many  cases,  but  it  can 
never  be  injurious,  and  in  a  great  proportion  it  would  be  exceedingly 
useful. 

Congenital  Debility. 

CASE  LVI. 

Relaxed  genital  organs — Spermatic  cords  varicose — Few  hut  debilitating 
nocturnal  pollutions — Opposite  effects  of  coitus — Unsuspected  diurncd 
pollutions — Constant  headache — Disordered  senses — Intellectxial  dehility — 
Hallucination — Tonic  treatment  at  the  age  of  twenty-one,  folloiced  by  re- 
covery. 

In  the  month  of  June,  1835,  General  Mina  placed  under  my  care  the 
son  of  one  of  his  friends,  who  had  been  treated  unsuccessfully  for  a  chronic 
cerebral  affection  by  distinguished  practitioners,  both  in  England  and  Ger- 
many. 

M.  P.  G ,   twenty-one  years  of  age,  was  well  made,  of  moderate 

height,  and  robust  appearance;    his  face  and  embonpoint  bespoke •  health, 


CONGENITAL    PEEDISPOSITION.  225 

although  he  had  complained  of  headache  for  several  years,  and  often  showed 
serious  derangement  of  his  ideas,  which  were  generally  wandering  and  ob- 
tuse. His  feeble  and  husky  voice,  and  timid  and  embarrassed  manners,  led 
me  to  suspect  masturbation ;  I  was  completely  mistaken,  however.  Whilst 
examining  an  inguinal  hernia,  which  had  come  on  without  apparent  cause,  I 
noticed  evident  marks  of  semen  on  the  patient's  shirt ;  and  he  told  me  that 
while  travelling  the  night  before,  he  awoke  deluged  with  this  ylairi/  matter ; 
that  he  often  experienced  similar  evacuations  without  dreams,  erections  or 
any  other  sensation  sufficient  to  awake  him.  Further  examination  convinced 
me  that  the  patient  passed  semen  also  at  stool,  and  that  his  urine  constantly 
contained  a  considerable  quantity.  I  was,  therefore,  convinced  that  the  sup- 
posed chronic  cerebral  affection  was  nothing  more  than  mistaken  spermator- 
rhoea— which  the  result  soon  confirmed. 

The  cause  of  these  discharges  was  sufficiently  obscure.  The  patient's 
parents  were  strong  and  healthy,  and  he  had  ten  brothers  and  sisters  all  in 
good  health ;  there  was  no  hereditary  disease  in  his  family,  and  his  infancy 
had  been  passed  without  ailment.  At  the  age  of  sixteen  nocturnal  pollu- 
tions had  occasionally  appeared,  without  dreams,  and  without  sensation ;  the 
patient  was  completely  ignorant  of  everything  appertaining  to  sexual 
intercourse,  as  well  as  masturbation.  He  was  passionately  fond  of  study. 
At  the  age  of  seventeen  he  had  frequent  headache,  and  disordered  vision ; 
obtuseness  in  his  ideas  ;  loss  of  memory;  intellectual  employment  fatiguing 
and  unrepaying ;    he  had  several  times,  too,  long  fits  of  unconsciousness 

without  apparent  cause.     At  the  age  of  eighteen,  M.  P.  G was  placed 

in  a  commercial  school  at  Paris  ;  two  months  afterwards  he  left  his  studies 
one  evening  on  account  of  a  violent  headache ;  a  vague  but  imperious  feel- 
ing, to  which  he  yielded,  impelled  him  towards  the  other  sex.  The  following 
day  he  was  much  better;  he  felt  more  vigorous  both  physically  and  morally. 
But  notwithstanding  this  beneficial  effect,  the  patient  yielded  only  once 
more,  although  he  felt  much  relieved  on  that  occasion  also. 

Soon  afterwards,  M.  P.  Q was  placed  in  a  commercial  house  in  Lon- 
don, where  he  worked  assiduously  for  two  months,  at  the  end  of  which 
time  he  suffered  from  headaches,  giddiness,  disordered  vision,  noise  in  his 
ears,  &c. ;  residence  in  the  country  produced  a  slight  improvement,  which 
was,  however,  lost  on  the  patient's  returning  to  the  same  occupation ;  so 
that  after  a  short  time  he  was  unable  either  to  write  or  to  keep  his  accounts. 
He  experienced  such  frequent  giddiness,  and  so  great  weakness  in  his  legs 
that  he  dared  not  go  out  alone.  At  length  his  intellect  became  deranged 
to  such  an  extent  that  he  doubted  everything  he  heard  or  saw,  all  that  he 
did,  and  even  his  own  existence.  By  degrees  his  digestion  also  became 
deranged,  and  his  medical  attendants  sent  him  to  travel  in  Belgium  and 
Germany.  During  this  long  journey  he  became  more  and  more  disordered; 
everything  seemed  illusory  and  fantastic ;  he  fancied  himself  in  a  painful 
dream.  He  imagined  too  that  every  one  was  ridiculing  him,  and  conspiring 
against  him  ;  and  he  especially  suspected  three  Englishmen  who  followed 
the  same  route,  and  who  he  thought  were  plotting  together  against  him. 
One  of  these  was  especially  hateful  on  account  of  his  ironical  manner ; 
and  the  patient  was  a  hundred  times  tempted  to  precipitate  this  gentleman 
into  the  Rhine  as  he  passed  him  on  board  the  steamboat;  these  hallucina- 
tions remained  on  the  patient's  memory  after  his  recover}^,  like  a  kind  of 
nightmare.     At  the  close  of  this  journey  he  was  brought  to  consult  me. 


226  CAUSES    OF    SPERMATOKRHCEA. 

When  I  saw  him  his  nocturnal  pollutions  recurred  only  at  intervals  of 
eight  or  ten  days,  which  did  not,  however,  prevent  their  debilitating  effects; 
these  were  the  more  remarkable  when  contrasted  with  those  of  coitus,  al- 
ready mentioned.  The  patient  too  experienced  the  same  state  of  weakness 
when  he  had  erotic  dreams  or  venereal  desires,  even  although  no  apparent 
discharge  took  place. 

These  phenomena  were  easily  explicable  by  the  presence  of  diurnal  pol- 
lutions;  but  there  was  nothing  to  account  for  the  early  development  and 
constantly  increasing  recurrence  of  these  abundant  discharges.  The  exa- 
mination of  the  inguinal  hernia  gave  some  information.  I  have  already 
stated  that  it  came  on  without  appreciable  cause  ;  announcing  great  re- 
laxation in  the  inguinal  rings;  the  opposite  side  too  showed  a  marked 
disposition  to  the  occurrence  of  hernia;  the  veins  of  both  spermatic  cords 
were  varicose ;  the  penis  of  moderate  size,  was  very  long  and  soft,  and  the 
scrotum  was  so  relaxed  that  the  patient  was  obliged  to  wear  a  suspensory 
bandage.  I  passed  a  very  large  catheter,  too,  into  the  bladder,  without 
experiencing  the  least  resistance,  and  without  the  patient's  giving  the  least 
sign  of  pain. 

The  union  of  all  these  circumstances  led  me  to  conclude  that  the  sper- 
matorrhoea was  exclusively  due  to  atony  of  the  ejaculatory  ducts;  and  con- 
sequently, I  daily  left  a  catheter  in  the  urethra  for  two  hours  at  a  time ;  at 
the  same  time  the  patient  took  iced  milk  three  times  a  day  ;  and  iced  wine 
mixed  with  Spa  water  at  his  meals ;  and  used  cold  lotions  frequently,  with 
a  hard  bed,  and  horse  exercise.  These  means  brought  about  a  prompt  and 
decisive  change ;  within  a  fortnight  the  patient's  headache  had  left  him,  to- 
gether with  the  aberrations  of  intellect  which  had  accompanied  it ;  his  per- 
ceptions became  clear,  his  ideas  precise,  his  motions  prompt  and  decided  ; 
the  use  of  mineral  waters,  especially  of  alternate  hot  and  cold  douches  on 
the  loins  and  perineum,  consolidated  his  cure. 

I  saw  M.  P.  G the  following  year,  and  also  in  August,  1838 ;  his 

diurnal  pollutions  have  not  reappeared ;  nocturyal  pollutions  happen  after 
prolonged  continence;  they  are  energetic,  and  do  not  injure  the  health.  All 
his  functions  are  perfectly  well  performed. 

This  case  is  another  example  of  the  powerful  effects  produced  on 
the  brain  by  involuntary  seminal  discharges.  In  the  present  case 
the  pollutions  evidently  arose  from  congenital  atony  of  the  genera- 
tive organs.  It  is  like  enough  that  I  should  not  have  discovered 
these  debilitating  discharges,  had  I  not  done  so  accidentally  while 
examining  the  patient's  inguinal  hernia.  Nothing  in  the  patient's 
conduct  could  have  led  me  to  suspect  the  presence  of  pollutions, 
and  his  constitution,  as  well  as  the  history  of  his  family,  did  not 
point  out  any  local  weakness.  On  the  contrary,  circumstances  were 
present  which  would  lead  away  from  the  true  cause  of  his  disorder; 
his  nocturnal  pollutions  were  very  rare,  and  coitus  was  on  both  occa- 
sions followed  by  remarkable  improvement  in  the  health.  This  may 
be  easily  explained  by  bearing  in  mind  what  I  have  already  said 
respecting  the  different  effects  of  different  kinds  of  spermatic  dis- 
charges ; — the  excitement  produced  by  the  normal  act  diminishing 
the  relaxation  of  the  tissues  and  the  abundance  of  the  involuntary 
discharges. 


CONGENITAL    PEEDISPOSITION.  227 

How  was  it  that  this  patient  did  not  show  more  inclination  towards 
the  other  sex,  especially  after  having  noticed  the  beneficial  effects 
of  his  first  intercourse  ?  He  attributed  this  indifference  to  the  pro- 
found melancholy  which  possessed  him  from  the  period  of  puberty ; 
but  this  sadness  disappeared,  and  his  ideas  completely  changed  after 
his  cure.  The  indifference,  then,  arose  from  the  diurnal  pollutions 
of  which  he  was  the  victim. 

This  patient's  hallucinations  were  of  the  same  nature  as  those  of 
Esquirol's  patient  (Case  thirty-two),  only  that  the  conviction  of  a 
general  conspiracy  against  him  was  more  confirmed.  If  in  one  of 
his  moments  of  rage  he  had  thrown  his  supposed  enemy  into  the 
Rhine,  would  this  hallucination  have  been  admitted  ?  If  so,  would 
its  cause  have  been  even  suspected  ? 

Varicocele. — I  have  met  with  many  cases  of  involuntary  seminal 
discharges  occurring  in  patients  who  were  affected  with  varicocele. 
I  have  at  present  before  me  three  consultations  and  numerous  notes 
of  such  cases  ;  but  they  are  for  the  most  part  incomplete,  because  I 
am  ignoranj;  of  the  results  of  the  means  employed.  I  will,  however, 
briefly  relate  all  that  can  be  gained  from  them  relative  to  sperma- 
torrhoea. 

One  of  these  patients  was  addicted  to  masturbation  about  the  age 
of  ten  ;  he  practised  it,  however,  much  less  frequently  than  the  ma- 
jority of  his  companions;  and  corrected  himself  at  the  age  of  fifteen. 
Another  committed  some  slight  venereal  excesses,  but  very  irregu- 
larly and  for  a  very  short  time  on  each  occasion.  A  third  suffered 
from  simple  blennorrhagia,  after  which  swelled  testicle  came  on  the 
day  after  a  ball.  A  distinguished  barrister  first  experienced  noctur- 
nal pollutions  during  the  period  of  his  examination;  afterwards  he  had 
numerous  relapses,  following  the  excitement  of  important  causes,  and 
was  obliged  to  give  up  his  profession,  notwithstanding  his  talent,  be- 
cause the  pollutions,  becoming  diurnal,  weakened  his  memory.  It 
is  probable  that  in  these  cases  no  bad  effects  would  have  been  pro- 
duced if  the  patients  had  not  been  predisposed  to  them.  Other 
patients  affected  with  varicocele  and  pollutions  pursued  courses  of 
life  which  might  be  considered  exemplary,  if  compared  with  the 
lives  led  by  hosts  of  individuals  who  never  suffer  any  bad  effects 
from  such  proceedings.  I  have  besides  questioned  those  patients 
who  have  consulted  me  for  varicocele  alone,  and  I  have  found  that 
the  greater  number  complained  of  want  of  power  in  the  organs.  Del- 
pech  made  the  same  remark;  and  he  attributed  this  want  of  power 
to  the  torpidity  of  the  venous  circulation  which  retarded  the  sperma- 
tic secretion ;  he  thought  too,  that  by  taking  away  the  varicose  veins 
he  would  be  able  to  restore  the  functions  to  their  normal  condition  ; 
the  unfortunate  death  of  the  author  of  this  proposition  is  sufficient 
to  show  its  fallacy.'     As  far,  however,  as  regards  the  debility  of  the 

'  The  unfortunate  Delpech  was  assassinated  in  tlie  middle  of  the  day  by  a  patient 
from  Bordeaux,  on  wliom  he  had  previously  operated  for  varicocele.  The  murderer 
immediately  afterwards  blew  his  own  brains  out. 


228  CAUSES    OF    SPERMATORRHCEA. 

spermatic  organs  in  such  persons,  I  agree  with  him  perfectly  ;  in- 
deed, it  is  a  point  which  I  have  observed  too  often  to  admit  of  my 
doubting  it.  I  have  also  remarked  that  in  many  of  these  cases  the 
testicles  are  soft  and  small,  and  when  the  spermatic  veins  of  one 
side  only  were  varicose,  I  have  invariably  remarked  that  the  testi- 
cle of  that  side  did  not  correspond  in  development  to  that  of  the 
other.     Pott  has  related  several  cases  of  the  same  kind. 

If  masturbation,  venereal  excesses,  orchitis,  &c.,  favor  the  devel- 
opment of  varicose  veins  in  the  spermatic  cords,  this  can  only  take 
place  in  persons  who  are  predisposed  to  that  disease  by  congenital 
weakness  of  the  parts  ;  for  many  persons  are  exposed  to  the  opera- 
tion of  all  these  causes  without  having  varicocele,  which  disease  often 
comes  on  without  appreciable  cause.  The  same  thing  happens  here 
as  in  varicose  veins  of  the  lower  extremities  ;  fatigue  of  the  parts, 
as  well  as  everything  which  hinders  the  free  return  of  blood,  un- 
doubtedly contributes  to  render  the  veins  varicose  ;  and  yet  are 
there  not  many  who  pass  hours  together  standing,  and  who  wear 
tight  garters,  but  nevertheless  do  not  suffer  from  varices  ?  whilst 
there  are  numbers  on  the  other  hand  who  are  victims  of  this  in- 
firmity without  being  particularly  exposed  to  the  action  of  such 
causes.  It  must,  therefore,  be  admitted  in  the-  latter  class  of  cases, 
that  there  is  some  primary  weakness  or  congenital  disposition  in  the 
affected  veins  to  become  varicose. 

Since,  then,  we  see  want  of  energy  in  the  genital  organs  so  fre- 
quently accompanying  varicocele,  it  is  evident  that  the  venous  sys- 
tem is  not  alone  in  a  state  of  atony  or  relaxation  ;  and  it  is,  there- 
fore, of  consequence  to  pay  attention  to  the  condition  of  the  veins 
in  order  to  judge  of  the  power  of  the  genital  organs  as  well  as  of 
the  predisposing  causes  of  involuntary  emissions.  Such  signs  point 
out  the  remedies  to  be  used  in  these  cases. 

CASE  LVII. 
Hypospadias — Impotence — Frequent  seminal  discharges. 

Morgagni  relates  with  bis  customary  precision,  an  interesting  case  of  im- 
potence, which  he  attributes  to  the  malformation  of  the  glans,  but  which 
was  evidently  due  to  involuntary  discharges ;  the  following  are  the  princi- 
pal circumstances. 

The  patient  was  scarcely  thirty ;  he  was  by  no  means  strong,  and  was 
affected  with  an  old  ophthalmic  disorder.  He  admitted  that  although  he 
bad  been  married  two  years,  he  had  never  had  sexual  intercourse ;  this  he 
attributed  to  the  glans  penis  being  curved  downwards,  and  perforated  near 
its  base,  instead  of  at  its  point.  The  infei-ior  wall  of  the  urethra  was  in 
fact  wanting  in  the  neighborhood  of  the  glans,  and  a  little  behind  it ;  the 
prepuce  was  divided  in  the  same  manner  and  resembled  that  of  the  clitoris. 
The  penis  was  of  its  natural  development,  the  testicles  were  large,  but  the 
scrotum  appeared  relaxed.  At  the  period  of  pubert}',  the  erections  had 
been  complete,  the  glans  being  fully  injected  as  well  as  the  rest  of  the  penisj 
an  uncomfortable  sensation  even  arose  in  the  part  where  the  urethra  was 


CONGENITAL    PREDISPOSITION.  229 

wanting;  but  this  sensation  diminished  by  degrees  in  proportion  as  the  glans 
entered  less  into  erection.  At  the  time  of  the  patient's  marriage  the  tume- 
faction of  the  glans  took  place  very  rarely;  at  last  it  ceased  entirely;  "the 
glans  remaining  flaccid  and  insensible  from  the  time  when,  in  useless  efiforts 
at  intercourse,  the  patient  discharged  large  quantities  of  semen,  which  escaped 
very  promptly." 

Morgagni  is  inclined  to  think  that  the  absence  of  the  urethra 
underneath  the  glans  was  the  cause  of  its  not  becoming  erect  in  this 
case ;  the  rest  of  the  penis  was  capable  of  erection,  but  the  glans 
being  a  portion  of  the  corpus  sjjongiosum,  and  receiving  its  blood 
from  the  bulb,  was  incapable  of  becoming  so.  This  explanation, 
although  plausible  and  founded  on  the  distribution  of  the  arteries 
of  the  penis,  rests  on  an  incorrect  hypothesis ;  for  in  cases  of  this 
nature  the  parietes  of  the  urethra  are  not  wanting,  there  is  only  de- 
fective union  in  the  median  line,  which  by  no  means  interferes  with 
the  presence  of  the  corpus  sjjongiosum,  nor  with  its  receiving  its 
proper  arteries.  Besides,  the  malformation  in  Morgagni's  case  was 
equally  fwresent  at  the  age  of  puberty,  yet  the  patient  experienced 
erections  at  that  time  into  which  the  glans  entered,  so  much  so,  in- 
deed, as  to  cause  a  painful  sense  of  dragging  in  the  situation  of  the 
urethra.  The  patient's  impotence  was,  therefore,  due  to  some  other 
cause,  and  this  cause  was  evidently  the  same  that  acted  in  case  fifty- 
five.  The  impotence,  therefore,  arose  from  habitual  and  unperceived 
seminal  discharges,  favored  by  the  congenital  debility  of  the  organs. 
Morgagni's  last  sentence  is  sufficient  to  prove  this.  When  did  the 
glans  entirely  cease  to  become  erect?  "From  the  time  when  in  useless 
eff"orts  at  sexual  intercourse,  the  patient  discharged  large  quantities 
of  semen,  which  escaped  very  promptly."  These  repeated  and 
abundant  seminal  discharges  then  rendered  the  erections  less  and 
less  energetic,  and  at  last  thoroughly  imperfect. 

The  rapidity  with  which  ejaculation  took  place  is  observed  in  all 
cases  of  this  nature  ;  and  this  hasty  emission,  whether  it  arise  from 
irritation  or  debility,  or  both,  which  opposes  intromission  as  much  as 
the  insufficiency  of  the  erections,  is  always  accompanied  by  diurnal 
pollutions  :  to  these,  therefore,  the  impotence  is  due  (although  very 
often  they  are  unsuspected),  and  they  are  invariably  exasperated  by 
unavailing  efiforts  at  coitus,  which  increase  the  irritation  and  debility 
of  the  parts.  On  the  other  hand,  too,  such  appreciable  discharges 
joined  to  those  which  are  unsuspected,  sufficiently  explain  why  the 
erections  become  daily  less  energetic,  and  the  formation  of  the  semen 
less  perfect. 

The  remarkable  coincidence  of  hypospadias  with  debility  of  the 
genital  apparatus  has  induced  me  to  quote  the  above  case.  Hypos- 
padias is  a  rare  malformation,  and  has  never  been  studied  in  reference 
to  its  connection  with  weakness  of  the  organs.  It  is  well  known  that 
Louis  XVI.  had  hypospadias,  and  the  Memoirs  of  Madame  de  Cam- 
pan  leave  no  doubt  that  his  marriage  was  not  consummated  for 
15 


230  CAUSES    OF    SPERMATOREHCEA. 

several  years.  I  have  met  with  one  case  of  hypospadias  in  the 
hospital  St.  Eloi ;  it  was  accompanied  with  nocturnal  and  diurnal 
pollutions,  but  I  only  had  an  opportunity  of  observing  the  patient 
for  two  or  three  days,  and  I  cannot  say  decidedly  that  these  pollu- 
tions arose  solely  from  a  natural  weakness  of  the  organs. 


CASE  LVIII. 

Atrophy  of  one  testicle  at  the  oge  of  eight — Nocturnal  and  afterwards  di- 
urnal pollutions — Frequent  desire  of  micturition,  &c. 

I  have  at  present  a  student,  act.  twenty-seven,  under  my  care,  who,  from 
the  period  of  puberty,  has  been  troubled  with  nocturnal  at  first,  and  after- 
wards with  diurnal  pollutions.  All  his  functions  are  deranged,  and  he  is  now 
incapable  of  any  intellectual  employment.  He  has  never  had  sexual  inter- 
course, and  he  has  not  been  addicted  to  masturbation.  When  about  eight  or 
nine  years  of  age  he  suffered  from  inflammation  of  the  left  testicle  without 
evident  cause.  After  having  continued  very  large  for  some  time,, the  organ 
atrophied  by  degrees,  so  that  it  is  reduced  to  the  size  of  a  horse-bean,  the 
spermatic  cord  being  also  very  thin.  The  urethra  is  extremely  sensitive, 
especially  in  the  neighborhood  of  the  prostate,  and  the  patient  makes  water 
very  frequently — this  symptom  dating  from  his  childhood. 

There  existed  without  doubt  in  this  unfortunate  individual  a  con- 
genital disposition  to  phlogosis  of  the  genito-urinary  organ  ;  this 
showed  itself  at  the  age  of  eight,  by  spontaneous  inflammation  of  the 
left  testicle ;  from  that  time  irritation  continued  in  the  neighborhood 
of  the  bladder,  and  extended  its  influence  to  the  right  testicle.  This 
accounts  for  the  occurrence  of  nocturnal  pollutions  at  the  age  of 
puberty.  Spontaneous  inflammation  of  the  testicles  in  childhood  is 
then  a  sign  of  a  morbid  condition  of  the  genital  organs,  and  the  de- 
struction of  one  of  the  testicles  does  not  remove  the  patient  from 
the  danger  of  involuntai*y  seminal  discharges,  which  may  even  be 
suflSciently  abundant  to  injure  the  health. 

Natural  Relaxation  of  the  Ejaculatory  Ducts. — There  are  a  cer- 
tain number  of  cases  of  involuntary  seminal  discharges,  which  it  is 
impossible  to  attribute  to  any  satisfactory  cause ;  which  are  not 
accompanied  by  any  sign  of  irritation ;  and  to  explain  which  we 
are  obliged  to  admit  a  natural  disposition,  debility  or  congenital  re- 
laxation of  the  spermatic  organs,  and  especially  of  the  ejaculatory 
ducts.  This  condition  sometimes  coincides  with  more  or  less  cha- 
racteristic external  signs,  but  in  other  cases  it  is  only  shown  by  its 
efi"ects.  The  following  remarkable  case  will  explain  what  I  have  to 
say  on  this  obscure  but  important  subject. 


CONGENITAL    PEEDISPOSITION.  231 


CASE  LIX. 

Lymphatic  temperament — Incontinence  of  urine — Neither  masturbation  nor 
sexual  intercourse — More  and  more  frequent  nocturnal  pollutions — Relaxa- 
tion of  the  sphincters  of  the  anvs  and  neck  of  the  bladder — Treatment 
unsuccessful. 

M.  M ,  of  very  marked  lymphatic  temperament,  was  subject  to  in- 
continence of  urine  up  to  the  age  of  twelve  or  thirteen.  His  religious 
enthusiasm  induced  him  to  embrace  the  ecclesiastical  profession.  He  had 
never  practised  masturbation  nor  had  sexual  intercourse.  Puberty  did  not 
take  place  until  the  age  of  eighteen,  but  was  accompanied  with  nocturnal 
pollutions — rare  at  first — then  more  frequent ;  and  at  length  occurring  daily 
and  quite  passively.  All  his  functions  were  successively  deranged,  and  at 
thie  age  of  twenty-three,  five  years  from  the  commencement  of  the  disorder, 
M.  M consulted  me  in  the  following  condition. 

Skin  white,  cold,  and  clammy;  limbs  rounded;  hair  white;  no  beard; 
pelvis  very  large  ;  hips  projecting ;  flesh  soft ;  genital  organs  pretty  well  de- 
veloped, but  very  flaccid;  scrotum  much  relaxed;  hair  very  scanty  ;  blindness 
nearly  total ;  enormous  dilatation  of  the  pupils ;  considerable  decrease  of  in- 
tellect and  memory ;  extreme  weakness  of  the  limbs ;  progression  almost 
impossible  without  the  support  of  a  stick;  digestion  difficult;  involuntary 
discharge  of  feces  several  times  a  day  ;  micturition  frequent  during  the 
day ;  incontinence  of  urine  at  night ;  nocturnal  pollutions  repeated  several 
times  at  night  without  erection  or  sensation ;  semen  very  fluid ;  urine  often 
muddy.  I  passed  an  immense  catheter  into  the  bladder  without  experienc- 
ing the  least  resistence,  or  giving  the  patient  the  slightest  pain  ;  the  anus 
was  almost  wide  open,  permitting  the  introduction  of  three  fingers  into  the 
rectum,  without  the  least  difficulty,  and  without  exciting  any  action  of  the 
sphincters. 

I  prescribed  aromatic  baths,  stimulating  frictions  and  applications;  ice 
internally  and  externally,  Spa  water,  quinine,  &c.  ;  and  1  performed  two 
cauterizations  of  the  urethra,  all  without  the  least  success  ;  after  four  months' 
treatment  I  lost  sight  of  this  unfortunate  patient,  leaving  him  in  just  the 
same  state  as  when  he  first  consulted  me. 

All  circumstances  combined  in  this  case  to  convince  me  that  the 
patient  spoke  truth  when  he  asserted  that  he  was  ignorant  of  mastur- 
bation and  had  never  had  sexual  intercourse.  The  incontinence  of 
urine  and  feces  ;  the  form  of  the  pelvis  ;  tJie  flaccidity  of  the  genital 
organs;  the  general  state  of  the  economy;  all  seemed  to  show  that 
the  ejaculatory  ducts  shared  the  relaxation  of  the  sphincters  of  the 
anus  and  bladder,  and  that  this  original  atony  was  the  sole  cause  of 
the  nocturnal  and  diurnal  pollutions.  This  case  is  the  most  remark- 
able one  of  the  kind  that  I  have  ever  met  with,  on  account  of  the 
combination  of  circumstances  that  accompanied  the  relaxation  of  the 
ejaculatory  ducts,  and  from  the  absence  of  every  complication  that 
could  have  excited  involuntary  seminal  discharges  ;  it  enables  us  to 
understand  cases  in  which  there  are  similar  but  less  marked  predis- 


232  CAUSES    OF   SPERMATORRH(EA. 

positions,  and  which  are  accompanied  by  less  evident  or  even  nearly 
inappreciable  signs. 

CASE  LX. 

SicMy  cMldhood — Extraordinary  nocturnal  'pollutions  at  sixteen — Some 
time  after,  pollutions  during  defecation — UJaculation  impossible — Slow 
discharge  of  semen  after  the  subsidence  of  erection — Urethral  canal  very 
slightly  sensitive — Prostatic  surface  hard  and  cartilaginous. 

In  the  year  1825,  I  was  consulted  by  a  medical  student,  set.  twenty-one, 
of  small  stature  and  spare  habit,  in  consequence  of  deafness,  which  had 
made  considerable  progress  during  two  years.  After  injecting  the  Eusta- 
chian tube  a  few  times,  applying  a  seton,  &c.,  the  beneficial  efiects  of  which 
were  very  trifling,  the  patient  spoke  to  me  about  nocturnal  and  diurnal  pol- 
lutions which  were  accompanied  by  extraordinary  circumstances.  The  fol- 
lowing are  the  chief  facts  of  the  case. 

The  patient's  health  was  weak  until  the  age  of  sixteen,  when  puberty 
occurred,  and  he  suffered  from  frequent  erections  and  nocturnal  pollutions. 
These  discharges  continued  from  that  time ;  they  were  often  excited  by 
lascivious  dreams,  but  were  not  always  preceded  by  erections ;  when  erec- 
tion occurred,  it  was  not  during  its  continuance  that  the  discharge  of  semen 
took  place,  but  only  after  the  swelling  of  the  penis  had  passed  off,  the 
matter  discharged  dribbling  over  the  neighboring  parts  instead  of  being 
forcibly  thrown  off  as  in  true  ejaculation.  This  matter  resembled  white 
of  egg,  and  stained  the  linen  in  the  same  manner  ;  it  was  often  so  abun- 
dant that  the  patient  was  compelled  to  change  his  shirt.  The  evacuations 
were  followed  by  debility,  languor,  and  headache.  Whatever  quantity  of 
semen  was  passed  he  never  experienced  the  slightest  voluptuous  sensation, 
so  that  at  first  he  thought  himself  affected  with  incontinence  of  urine,  and 
when  these  abundant  discharges  took  place,  not  being  able  to  prevent  them, 
he  rose  suddenly  to  micturate.  Often  while  at  stool  a  similar  discharge 
took  place  in  greater  or  less  quantity,  according  to  the  degree  of  constipa- 
tion. 

Sexual  intercourse  had  been  very  rare,  and  always  accompanied  with 
similar  circumstances ;  the  erections  were  energetic  and  long  continued ; 
indeed,  they  lasted  an  indefinite  time,  for  fatigue  alone  put  an  end  to  the 
act :  seminal  discharge  never  under  any  circumstances  took  place  until  the 
cessation  of  the  erection.  The  same  thing  occurred  during  a  few  attempts 
at  masturbation,  which  the  patient  practised  from  curiosity,  for  he  never 
experienced  sufficient  pleasure  either  in  these  manoeuvres  or  in  coitus,  to 
practise  them  from  inclination ;  he  had  an  ardent  desire  to  get  rid  of  his 
nocturnal  pollutions,  which  he  believed  arose  from  defective  contractility  in 
the  seminal  vesicles. 

This  patient  was  very  thin  and  remarkably  pale ;  his  digestion  was  much 
disordered;  his  memory  treacherous;  his  intellect  weakened;  and  the  least 
application  to  study  excited  obstinate  and  almost  constant  headache.  He 
experienced  noise  in  his  ears  ;  and  this  deafness  was  very  probably  due  to 
the  same  cause,  although  he  imagined  himself  the  subject  of  some  local 
affection. 

I  did  not  observe  anything  particular  in  the  patient's  form  nor  in  the  size 
and  consistence  of  the  external  organs  of  generation,  but  on  passing  a 


CONGENITAL    PREDISPOSITION.  233 

large  catheter  into  the  canal,  I  remarked  that  it  possessed  very  little  sensi- 
bility;  and  especially  in  the  prostatic  region,  where  the  instrument  was 
arrested.  On  taking  a  smaller  one  I  succeeded  in  reaching  the  bladder  ; 
and  in  passing  the  prostate,  the  instrument  seemed  to  rub  on  a  hard  carti- 
laginous surface,  which,  however,  was  quite  smooth  and  regular.  The 
patient  remained  quite  passive  during  this  examination,  which  lasted  a  long 
time.  The  prostate  examined  through  the  rectum  did  not  seem  larger  or 
less  regular  than  natural.  Its  firmness  presented  nothing  remarkable. 
These  examinations,  repeated  at  the  intervals  of  several  days,  always  gave 
similar  results. 

I  performed  cauterization  of  the  prostatic  portion  of  the  urethra  in  the 
hope  of  modifying  its  abnormal  condition,  but  no  benefit  was  obtained. 
Dilatation  by  means  of  gum-elastic  catheters  was  not  of  great  service. 

This  is  the  only  case  of  the  kind  of  which  I  am  aware  ;  it  presents 
characters  quite  different  from  those  which  generally  accompany 
nocturnal  and  diurnal  pollutions ;  but  it  does  not  the  less  belong  to 
the  class  of  such  cases  caused  by  original  disposition  in  the  spermatic 
organs.  The  patient's  statements  bore  the  semblance  of  truth.  He 
suffered  from  pollutions  many  years  before  attempting  either  coitus 
or  masturbation ;  indeed,  it  was  only  in  the  hope  of  relieving  his 
disorder  that  he  committed  these  acts  ;  for  he  was  not  enticed  to 
them  by  any  feeling  of  pleasure.  His  remarkable  seminal  discharges 
seem  to  have  arisen  from  the  induration  and  loss  of  sensibility  of  the 
surface  of  the  prostate  and  neighboring  parts,  and  this  condition 
seems  to  have  been  congenital. 

Symptoms  of  Debility  of  the  Genital  Organs. — Before  proceeding 
further,  it  may  be  as  well  to  consider  for  a  moment  the  characteristics 
we  have  already  noticed,  as  showing  debility  of  the  genital  organs. 

We  have  seen  that  excessive  development  of  the  prepuce  arises 
from  smallness  of  the  penis,  and  that  in  the  same  individual  the 
scrotum  is  often  much  folded  and  retracted  towards  the  pubes,  be- 
cause the  testicles  are  very  small.  Such  an  elementary  condition  of 
the  erectile  tissues  and  secreting  organs  necessarily  augurs  little 
energy  in  these  fundamental  parts  of  the  genital  apparatus,  and 
must  prove  an  unfavorable  prognostic  as  regards  the  condition  of 
the  ejaculatory  ducts,  seminal  vesicles,  and  other  parts  removed 
from  external  examination.  But  these  characters  are  not  always 
equally  marked,  and  do  not  always  stand  alone. 

Hypospadias  arises  from  defective  union  of  the  opposite  parietes  of 
the  urethra ;  and  whatever  may  have  been  the  cause  of  this  arrested 
development,  it  indicates  debility  of  the  parts,  because  their  forma- 
tion has  not  been  completed.  The  parts  have  wanted  energy  or  vital 
force  from  the  beginning.  Is  it  likely  that  this  condition  will  be 
altered  later  in  life  ?  All  I  have  seen  of  these  cases,  leads  me  to 
a  negative  conclusion.  Cases  of  epispadias,  too,  consisting  of  defec- 
tive union  of  the  corpora  cavernosa,  and,  still  more  serious,  eversion 
of  the  bladder  arising  from  a  similar  cause,  support  this  opinion ; 


234  CAUSES    OF    SPEEMATOEEH(EA, 

such  individuals  are  even  more  feeble,  in  respect  of  their  genital 
functions,  than  those  afflicted  with  hypospadias. 

The  following  circumstance,  too,  may  be  referred  to  the  same 
cause,  although  it  is  less  evident.  All  surgeons  who  are  frequently 
in  the  habit  of  passing  instruments  into  the  urethra,  are  aware  that 
great  differences  exist  with  respect  to  the  size  of  the  meatus.  In 
some  cases  it  is  exceedingly  small,  and  placed  at  the  summit  of  the 
glans ;  in  others,  again,  it  is  large,  gaping,  and  extends  from  the  apex  to 
the  corona  glandis,  or  even  lower.  It  is  evident,  that  this  increased 
size  of  the  meatus  arises  from  the  same  cause  as  hypospadias,  that 
is  to  say,  from  defective  union  of  the  two  walls  of  the  urethra.  In 
some  cases,  it  seems  a  commencing  hypospadias,  the  opening  descend- 
ing lower  than  the  glans.  Now,  I  have  met  with  few  cases  of  in- 
voluntary seminal  discharges  where  the  urinary  meatus  was  very 
contracted,  and  in  all  cases  of  this  kind  that  I  have  seen,  the  disorder 
had  been  produced  by  repeated  attacks  of  blennorrhagia,  serious  and 
long  continued  abuses,  or  great  sexual  excesses,  thus  showing  con- 
siderable activity  of  the  genital  functions ;  whilst,  on  the  other  hand, 
I  have  met  with  numerous  involuntary  discharges  in  those  whose 
meatus  was  larger,  and  such  discharges  have  been  produced  by  com- 
paratively slight  causes,  and  were  much  more  difficult  of  relief. 

My  practice  of  examining  all  such  patients  with  a  large  catheter, 
in  order  to  ascertain  the  degree  of  sensibility  of  the  urethral  mucous 
membrane,  led  me  to  make  this  observation  long  since,  and  I  have 
since  found  it  remarkably  constant.  Generally,  in  cases  of  large 
orifice,  the  remainder  of  the  urethra  as  well  as  the  neck  of  the  blad- 
der is  also  very  large,  which  might  leave  one  to  suppose  that  the 
ejaculatory  ducts  may  partake  of  the  same  condition.  However  this 
may  be,  I  believe  I  may  mention  extended  orifice  of  the  urethra,  as 
a  sign  of  congenital  debility  of  the  organs,  and  consequently  of  pre- 
disposition to  involuntary  discharges. 

The  firmness  of  the  erectile  tissues,  also,  differs  much  in  different 
individuals,  independently  of  their  size  and  form.  Whenever  I  have 
observed  the  penis  resting  on  the  scrotum,  the  corpora  cavernosa 
empty,  soft,  flaccid,  and  without  resistance  or  elasticity  on  pressure, 
I  have  remarked  that  the  organs  possessed  little  energy,  and  that  the 
powers  of  resistance  to  causes  capable  of  inducing  involuntary  dis- 
charges was  very  slight,  whilst  these  were  always  difficult  of  cure. 

In  cases,  too,  where  the  glans  presents  a  remarkable  development 
in  proportion  to  the  penis,  the  latter  being  long  in  the  corpora  caver- 
nosa, whilst  the  former  is  swollen,  overshadows  the  corpora  caver- 
nosa, and  is  always  uncovered,  or,  at  all  events,  badly  covered  by 
the  prepuce  ;  the  parts  want  energy.  The  erections  are  often  in- 
complete in  such  cases,  especially  towards  the  base  of  the  penis. 

As  regards  the  testicles,  their  smallness  is  not  the  only  circum- 
stance worthy  of  consideration.  Many  of  my  patients  have  been 
afflicted  with  inguinal  hernia,  frequently  congenital. 


CONGENITAL    PREDISPOSITION.  235 

Congenital  hernia  must  be  attributed  to  one  of  the  following  causes ; 
either  the  inguinal  canal  has  wanted  contractile  power,  the  process 
of  peritoneum  accompanying  the  testicle  has  been  distended  with 
serum,  or  the  testicle  has  descended  late  into  the  scrotum.  Under 
all  these  circumstances  there  is  evidently  radical  debility  of  the  parts. 
It  may,  indeed,  diminish  considerably  as  age  advances,  but  we  can 
never  expect  to  find  the  parts  remarkable  for  their  energy.  Since  I 
have  directed  my  attention  to  this  subject,  I  have  constantly  noticed, 
that  patients  afflicted  with  congenital  hernia  presented  much  smaller 
testicles  than  those  of  healthy  persons  of  corresponding  age.  The 
following  fact,  too,  is  very  decisive.  When  hernia  is  present  on  one 
side  only,  the  corresponding  testicle  is  always  smaller  than  the  op- 
posite one,  and  frequently  this  difference  extends  to  half  the  size  of 
the  organs.  For  a  long  time  I  fancied  this  small  size  of  the  testicle 
arose  from  compression  of  the  parts  by  the  hernial  sac,  but  I  have 
met  with  the  same  circumstance  in  persons  who  early  wore  a  truss. 
I  then  thought  that  compression  of  the  cord  by  the  pad  of  the  truss, 
might  give  rise  to  this  defect,  but  I  have  not  noticed  corresponding 
conditions  in  those  who  have  worn  a  truss  for  accidental  hernia.  The 
descent  of  the  testicle  into  the  scrotum  often  does  not  take  place  until 
long  after  birth,  and  in  one  of  the  cases  I  have  related,  it  was  not 
complete  until  the  age  of  twenty-eight  (case  fifty-four).  In  all  the 
cases  of  this  kind  that  I  have  had  opportunities  of  observing,  the 
organ  has  been  far  from  possessing  its  normal  size  and  form  ;  and 
still  further,  in  cases  where  I  have  had  an  opportunity  of  examining, 
after  death,  the  bodies  of  those  whose  testicles  had  not  descended,  I 
have  invariably  found  the  body  of  the  gland  small,  soft,  and  elongated, 
and  the  epidid3'mis  deformed  and  unfolded.  I  have  frequently,  too, 
ascertained  the  exactitude  of  the  opinions  of  Cloquet  on  the  causes 
that  oppose  the  descent  of  the  testicle  ;  this  distinguished  observer 
has  pointed  out  that  the  testicles  are  always  detained  either  by  some 
malformation  or  adhesion,  and  such  alterations  must  necessarily  in- 
fluence the  functions  of  the  organ. 

To  resume,  then ;  congenital  hernia,  slow  descent  of  the  testicles 
into  the  scrotum,  or  their  final  retention  in  the  abdomen,  must  be 
attributed  to  debility  of  the  parts,  to  adhesions  or  to  alterations  in 
their  structure,  which  must  more  or  less  injure  their  functions. 

The  form  of  the  testicle  is  also  of  considerable  importance.  The 
body  ought  to  be  ovoid,  regular,  and  smooth  ;  the  least  inequality 
observed  on  its  surface  denotes  some  internal  organic  alteration. 
The  size  of  the  epididymis  should  be  proportioned  to  that  of  the 
gland  itself;  any  swelling  of  this  part  shows  that  inflammation  has 
taken  place,  and  has  not  been  entirely  removed.  Such  inflammation 
may  have  left  marks  of  its  presence  in  other  parts  through  which 
the  semen  passes,  and  consequently,  in  the  seminal  vesicles,  and 
even  after  it  has  been  completely  removed,  is  very  likely  to  return 
in  the  altered  tissues.  It  often  happens  that  neither  children  nor 
their  parents  are  able  to  assign  any  cause  for  the  occurrence  of  these 


236  CAUSES    OF    SPEEMATORRHCEA. 

inflammations  either  because  they  take  place  during  early  childhood, 
or  because  they  come  on  without  any  appreciable  injury.  I  have  met 
with  more  than  one  patient  who  fancied  that  he  had  three  testicles, 
and  this  delusion  has  generally  arisen  from  the  increased  develop- 
ment of  the  epididymis  forming  a  kind  of  supplementary  swelling 
attached  to  the  testicle.  Whenever  I  have  found  this  swelling  con- 
siderable, the  true  testicle  has  been  smaller  than  natural,  and  in  a 
few  cases  it  was  completely  atrophied.  The  investigations  I  have 
made  in  such  cases  have  convinced  me  that  the  organ  did  not  act, 
or  acted  badly.  The  patients  are  not,  however,  removed  from  the 
dangers  of  involuntary  discharges  by  this  circumstance,  because  the 
two  organs  are  not  equally  affected.  I  have  related  a  case,  in  which 
one  of  the  organs  was  completely  atrophied  from  infancy,  notwith- 
standing which  obstinate  nocturnal  pollutions  occurred  at  puberty  : 
these  were  only  attributable  to  active  irritation  of  the  other  organ. 

Every  alteration,  then,  in  the  form  of  the  testicles,  must  be  attri- 
buted to  some  old  standing  affection,  and  announces  some  internal 
lesion,  which  necessarily  injures  the  functions  of  the  part,  and  warns 
us  of  the  possible  occurrence,  at  some  time  or  other,  of  other  affec- 
tions of  the  same  organs.  However  slight  it  may  be,  this  alteration 
in  the  form  of  the  testicles  merits  serious  consideration  in  attempting 
to  appreciate  the  amount  of  the  virile  powers,  and  the  disposition  to 
other  diseases  of  the  spermatic  organs. 

I  may  make  just  the  same  remark  concerning  the  vasa  deferentia. 
When  they  are  so  thin  that  difficulty  occurs  in  distinguishing  them 
from  the  other  structures  of  the  spermatic  cord,  it  is  a  sign  of  de- 
bility; but  this  sign  is  never  met  with  alone  ;  the  testicles  are  always 
small,  sometimes  even  rudimentary ;  all  the  secreting  apparatus 
seems  to  remain  in  the  same  condition  as  before  puberty.  When,  on 
the  other  hand,  the  vasa  deferentia  are  swollen,  knotty,  or  enlarged, 
towards  the  epididymis,  it  is  evident  that  they  have  been  previously 
the  seat  of  some  inflammation. 

Softness  and  flaccidity  of  the  testicles  also  show  little  energy  in 
the  gland  whatever  may  be  its  size.  I  have  met  with  this  symptom 
in  many  patients  remarkable  for  their  continence,  and  the  severity 
of  whose  voluntary  discharges  bore  no  relation  to  the  slight  acci- 
dental causes  that  excited  them.  On  the  other  hand,  this  flaccidity 
of  the  testicle  is  usually  accompanied  by  a  similar  condition  of  the 
corpora  cavernosa,  which  justifies  one  in  presuming  that  the  portions 
of  the  genital  apparatus  which  are  removed  from  external  examina- 
tion, partake  of  a  like  disposition. 

I  have  already  stated,  that  varicocele  must  be  regarded  as  a  sign 
of  debility  of  the  genital  organs.  The  debility  of  the  venous  system 
of  the  testicle  justifies  us  in  supposing  a  want  of  energy  in  the  re- 
mainder of  the  secretory  apparatus  ;  besides  which  the  stoppage  of 
the  circulation  through  the  veins  of  the  cord  must  injure  the  capil- 
lary circulation  in  the  testicles,  and  consequently,  retard  the  secretion 
of  semen.     I  have  noticed  this  in  cases  of  simple  engorgement  of 


CONGENITAL    PEEDISPOSITION.  237 

the  veins  of  the  cord,  especially  when  coincident  with  considerable 
elongation  of  the  organ. 

Encysted  hydrocele  developed  in  the  midst  of  these  vessels  pre- 
sents the  same  indication  for  the  same  reasons. 

Again,  all  the  parts  of  which  I  have  spoken  may  possess  their  ordi- 
nary volume  and  natural  form,  but  yet  may  present  a  decided  flac- 
cidity  announcing  serious  debility.  This  relaxation  especially,  is 
easily  noticed  in  the  scrotum.  Not  only  does  this  organ  extend  to 
a  great  length,  but  is  soft,  smooth,  and  without  hair  or  folds  ;  its 
surface  is  moist  ;  no  motion  occurs  in  it  from  the  contraction  of  the 
dartos  or  cremaster  muscle,  and  its  cellular  tissue  is  often  infiltrated 
with  serum.  The  most  remarkable  case  of  this  kind  that  I  have 
met  with,  is  that  related  at  page  231,  case  59,  in  which  no  sexual 
desire  was  ever  manifested,  but  the  subject  of  which,  at  the  age  of 
puberty,  became  subject  to  pollutions  which  nothing  relieved. 

Lastly,  all  my  patients  whose  virile  powers  were  originally  weak, 
had  very  sharp  intonation  of  voice,  sometimes  quite  falsetto.  Their 
hairy  system,  too,  was  little  developed.  One  patient,  at  the  age  of 
seventeen,  had  not  a  single  hair  on  his  chin  or  his  genital  organs. 
These  characters  resemble  those  found  in  eunuchs,  with  this  differ- 
ence, that  the  health  of  eunuchs  does  not  become  disordered. 

Symptoms  affecting  the  Urinary  Organs  during  Childhood. — The 
spermatic  apparatus  does  not  attain  its  full  development  until  the 
age  of  puberty,  but  the  urinary  organs  perform  their  functions  from 
the  period  of  birth.  The  connection  that  exists  between  the  two 
systems  is  so  intimate,  that  the  observations  drawn  from  the  one 
first  in  action  foreshadow  the  affections  to  which  the  other  may 
become  liable. 

Incontinence  of  Urine. — It  must  have  been  noticed,  that  in  several 
of  the  cases  in  which  involuntary  discharges  were  manifested  spon- 
taneously or  from  very  slight  causes,  the  patient  had  been  subject 
to  incontinence  of  urine  from  infancy.  I  have  met  with  numerous 
cases  in  which  this  was  the  case,  and  they  were  all  remakable  for 
the  facility  with  which  involuntary  discharges  occurred.  I  shall, 
therefore  briefly  review  such  circumstances  in  these  cases,  as  may 
throw  any  light  on  the  connection  existing  between  congenital  affec- 
tions of  the  urinary  passages  and  involuntary  seminal  discharges. 

In  proportion  as  the  child's  intellect  becomes  awakened,  he  un- 
derstands the  care  lavished  on  keeping  him  clean,  and  accustoms 
himself  to  assist,  until  at  length  he  arrives  at  an  age  when  he  has 
acquired  suflScient  empire  over  his  habits  to  avoid  soiling  his  bed 
or  his  clothes,  at  least  except  in  cases  of  accident.  This  period 
varies  according  to  the  child's  education  and  mental  progress.  But 
when  the  cerebral  functions  are  thoroughly  developed,  and  the  most 
determined  will,  and  best  sustained  attention,  are  not  sufficient  to 
prevent  the  untimely  discharge  of  the  urine,  there  is  a  more  or  less 
disgusting  infirmity.  Punishment  has  no  effect  ;  it  is  from  the  me- 
dical man  that  aid  must  be  sought. 


238  CAUSES    OF    SPEEMATORRHGEA. 

This  condition  of  the  urinary  organs  may  present  infinite  shades 
of  variety  ;  the  worst  is  that  in  which  the  child  is  unable  to  hold 
his  urine,  even  when  awake,  so  that  it  escapes  in  an  almost  continu- 
ous manner  without  his  knowledge.  This  degree  of  incontinence  is 
seldom  observed,  except  in  idiots,  whom  we  must  leave  out  of-  the 
question,  because  of  their  want  of  intelligence,  leaving  them  in 
precisely  the  same  condition  as  the  infant  in  the  cradle.  Next 
come  those  cases  in  which  the  neck  of  the  bladder  does  not  contract 
strongly  enough  to  prevent,  for  any  length  of  time,  the  passage  of 
urine,  even  during  walking  ;  so  that  when  the  desire  cannot  be  im- 
mediately satisfied,  the  want  of  power  in  the  neck  of  the  bladder  al- 
lows a  portion  of  the  urine  to  escape,  notwithstanding  all  the  efforts 
of  the  will.  It  is  evident,  that  in  such  patients  the  urine  will  escape 
much  more  readily  during  the  night.  When  it  is  only  during  sleep 
that  the  escape  of  urine  takes  place,  the  infirmity  is  grievous  enough, 
but  even  then  it  may  present  many  shades  of  severity.  In  some 
cases,  the  involuntary  emission  takes  place  every  night ;  in  others  it 
only  occurs  when  the  bladder  was  not  carefully  emptied  before  the 
patient  went  to  sleep,  or  because  a  large  quantity  of  fluid  had  been 
drunk  during  the  evening.  And  lastly,  in  a  few  cases,  the  discharge 
is  nearly  voluntary,  because  it  follows  some  dream  excited  by  the 
distension  of  the  bladder  ;  in  these  cases  it  may  be  considered  ra- 
ther as  an  accident  than  as  a  habit. 

Great  difference  also  exists  in  the  duration  of  this  infirmity :  in 
the  worst  cases  it  continues  after  puberty — more  or  less  changed, 
however,  according  to  the  influence  which  this  important  period  of 
life  exercises  on  the  constitution.  In  all  my  patients  who  had  pol- 
lutions after  incontinence  of  urine,  I  have  remarked  that  the  latter 
infirmity  continued  at  least  until  the  age  of  seven  or  eight  years  ;  in 
many  it  continued  until  the  approach  of  puberty,  and  such  patients 
always  retained  a  frequent  desire  of  emptying  the  bladder,  as  well 
as  considerable  difficulty  in  resisting  that  desire,  especially  when 
acting  energetically. 

It  is  evident,  from  what  I  have  just  stated,  that  incontinence  of 
urine  diminishes  in  proportion  as  the  constitution  gains  strength, 
and  that  it  generally  ceases  entirely  at  the  age  of  puberty,  or  is,  at 
least,  always  considerably  modified  ;  and  this  is  enough  to  show,  that 
the  infirmity  arises  from  original  debility  of  the  urinary  passages. 
The  treatment,  too,  that  is  most  successful,  supports  this  opinion. 
All  useful  remedies  are  derived  from  the  tonics  and  astringents.  I 
have  invariably  found  benefit  from  aromatic  baths  in  such  cases, 
and  I  have  now  treated  a  vast  number  of  them.  I  consider,  there- 
fore, that  hicontinence  of  urine  arises  from  atony  or  debility  of  the 
neck  of  the  bladder. 

It  is  not  without  reason,  then,  that  the  approach  of  puberty  is  con- 
sidered likely  to  efi'ect  a  cure  in  such  cases  :  such  a  result  is  explained 
by  the  urinary  passages  sharing  the  excitement  set  up  at  this  period 
in  the  genital  organs  ;  and  this  intimate  connection  is  sufficient  to 


CONaENITAL    PREDISPOSITION.  239 

point  out  that  incontinence  of  urine  in  childhood  is  a  bad  symptom, 
when  considered  in  connection  with  the  powers  of  the  genital  organs, 
in  after  life.  The  cases  I  have  seen  leave  no  doubt  on  my  mind  on 
this  subject ;  and  I  should  add  that  aromatic  baths  have  been  very 
useful  in  cases  complicated  in  this  manner.  After  aromatic  baths  I 
may  mention  cold  bathing,  ferruginous  preparations,  quinine,  co- 
lumba,  &c.,  which  are  also  useful  in  relieving  the  incontinence  of 
urine  itself.  Sulphuretted  baths  have  also  frequently  produced  good 
effects. 

Retention  of  Urine. — This  accident  is  very  rare  in  childhood,  I 
have,  however,  notes  of  two  cases  of  obstinate  involuntary  discharges 
in  which  it  occurred.  In  the  first  case,  frequent  retention  took  place 
about  the  age  of  two  years,  and  was  occasionally  so  serious  that 
the  aid  of  the  catheter  was  required  for  its  relief.  Up  to  the  age 
of  sixteen,  too,  the  patient  was  never  able  to  pass  urine  without 
making  ineffectual  efforts  for  a  quarter  of  an  hour  or  more ;  and 
even  when  he  consulted  me  he  was  obliged  to  wait  five  or  six  mi- 
nutes before  the  discharge  took  place.  He  was  also  subject  to  hse- 
morrhoids  from  infancy,  which  is  very  rare.  The  susceptibility  of 
the  genital  organs  was  so  great  in  this  patient,  that  pollutions  were 
produced  by  viewing  lithographic  plates  showing  the  anatomical  de- 
tails of  pregnacy. 

The  other  patient  was  a  young  man,  ast.  twenty-one,  who  con- 
sulted me  for  pain  in  his  chest  and  stuttering,  which  had  come  on 
after  puberty.  Retention  of  urine  occurred  occasionally  during  his 
childhood  up  to  so  advanced  a  period  that  he  was  able  to  furnish  an 
exact  detail.  At  the  age  of  fifteen,  after  having  travelled  some  time 
with  a  female — causing  him  considerable  excitement — he  passed  a 
large  quantity  of  semen  with  the  last  drops  of  his  urine  ;  afterwards 
the  same  circumstance  frequently  occurred  without  any  previous 
excitement.  He  noticed  also  that  he  passed  semen  during  efforts  at 
stool.  He  occasionally  practised  masturbation,  but  at  very  distant 
intervals,  and  he  never  passed  on  such  occasions  more  than  two  or 
three  drops  of  semen.  He  had  opportunities  of  sexual  intercourse 
six  times  in  four  years,  and  on  each  occasion  found  himself  completely 
impotent.  This  patient  deceived  himself  curiously  as  to  the  cause 
of  his  want  of  power  :  once  he  imagined  that  it  arose  from  the  dis- 
gust inspired  by  a  prostitute  ;  once  from  the  respect  he  felt  towards 
a  mistress ;  on  another  occasion  he  eat  too  much  before  going  to  his 
rendezvous  ;  at  other  times  he  had  drunk  too  much  punch,  eaten  too 
many  strawberries,  &c.  I  mention  these  subterfuges,  because  pa- 
tients who  are  in  this  unfortunate  position  take  vast  trouble  to  de- 
ceive themselves. 

The  impotence  in  this  case  arose  from  diurnal  pollutions  which 
had  evidently  long  preceded  the  rare  attempts  at  masturbation  which 
the  patient  committed.  He  came  to  consult  me  for  an  affection  of 
the  chest,  and  stated  that  he  should  return  shortly.  Two  years  after- 
wards, however.  I  learned  from  his  elder  brother,  who  consulted  me 


240  CAUSES    OF    SPEEMATORRH(EA. 

for  a  similar  affection,  that  he  became  so  ill  as  to  be  unable  to  under- 
take the  journey,  and  that  he  died  at  the  expiration  of  three  months. 
His  brother  strikingly  resembled  this  patient,  not  only  physically 
but  morally  ;  he  was  also  affected  with  stuttering.  There  was,  there- 
fore, in  these  two  brothers,  a  congenital  predisposition  to  involuntary 
seminal  discharges,  shown  in  the  younger  by  very  early  retention  of 
urine.  The  younger  one,  too,  died,  while  the  other  recovered  easily 
enough. 

The  following  consultation  has  recently  been  sent  me.  The  pa- 
tient's grandfather  died  of  a  calculous  affection  ;  his  father  is  of  very 
nervous  temperament,  and  subject  to  retention  of  urine  arising  from 
affection  of  the  prostate ;  the  patient  himself,  born  during  the  dis- 
turbances in  La  Vendue,  has  always  been  delicate  and  very  irritable. 
He  has  never  been  able  to  empty  his  bladder  completely,  whatever 
efforts  he  may  make  for  that  purpose,  and  the  first  jet  of  urine  is 
always  long  in  appearing.  He  practised  masturbation  very  rarely 
when  between  fourteen  and  fifteen  years  of  age.  He  is,  however, 
subject  to  debilitating  nocturnal  pollutions,  which  have  injured  his 
health.  Warm  baths,  abstinence  from  wine,  and  a  non-stimulating 
diet,  together  with  refreshing  beverages,  were  the  means  which  pro- 
duced most  benefit. 

In  all  cases  of  early  retention  of  urine,  a  decided  disposition  to 
irritation  of  the  prostate  is  to  be  suspected,  instead  of  debility  and 
relaxation  of  the  parts  such  as  are  found  in  persons  who  have  been 
subject  to  incontinence  when  children. 

To  resume,  then  :  incontinence  of  urine  is  a  symptom  the  more 
serious  in  respect  to  the  genital  functions  in  proportion  as  it  is  more 
complete  and  prolonged,  and  the  pollutions  which  follow  it  so  easily 
are  to  be  attributed,  in  a  great  majority  of  cases,  to  congenital  re- 
laxation, or  debility.     Such  pollutions  are  always  very  obstinate. 

Retention  of  urine  announces  just  as  surely  a  disposition  to  phlo- 
gosis  in  the  prostatic  portion  of  the  urethra  ;  and  this  is  more  marked 
in  proportion  as  the  retention  occurs  early  in  childhood,  a  period  at 
which  the  organs  are  not  exposed  to  the  irritations  that  act  on  them 
after  puberty. 

Hereditary  Transmission. 
CASE  LXI. 

Blennorrhagia  at  the  age  of  twenty-one — Pains  in  the  testicles — Pollutions 
during  four  years — Serious  gastric  and  cerebral  symptoms  occurring  in 
paroxysms — Hereditary  predisposition — Iced  milk —  Cauterization — 
Acup u ncture — Sulphu retted  ha ths — Peco very . 

In  November,  1835,  Dr.  Guillemot  requested  my  opinion  on  a  patient  of 
his,  whom  he  thought  affected  with  chronic  cerebral  affection.  The  fol- 
lowing are  the  chief  facts. 


CONGENITAL    PREDISPOSITION.  241 

M.  M ,  of  lymphatico-nervous  temperament,  and  excellent  disposition, 

whose  father  had  been  weak  and  unhealthy,  passed  his  childhood  without 
suflfering  from  any  serious  disease,  but  was  always  subject  to  diarrhoea,  ac- 
companied by  very  painful  tenesmus,  which  generally  yielded  to  slight  me- 
dical treatment,  but  was  reproduced  from  very  slight  causes.  He  led  a 
sedentary  studious  life,  and  had  never  committed  excesses  of  any  kind. 

In  1827,  at  the  age  of  twenty-one,  he  contracted  simple  blennorrhagia, 
which  yielded  quickly  to  the  use  of  demulcents ;  soon  after,  he  experienced 
a  vague  dull  pain  in  the  testicles,  which  troubled  him  much  on  account  of 
its  seat  and  its  constancy,  although  his  medical  attendants  did  not  consider 
it  of  consequence.  He  had  also  repeated  nocturnal  pollutions,  followed  by 
fatigue  and  general  uneasiness,  especially  when  they  occurred  very  frequently. 
His  erections,  too,  were  sometimes  painful.  During  four  years,  he  suffered 
constantly  from  indisposition  ;  he  had  frequent  attacks  of  indigestion,  repeated 
headache,  and  sudden  attacks  of  giddiness,  although  these  were  slight  and 
passing.  His  memory  and  aptitude  for  intellectual  employment  wore  dimi- 
nished. In  1831,  he  had  strange  noises  in  his  right  ear,  accompanied  with 
buzzing  and  momentary  deafness,  which  went  off"  and  returned  without  evi- 
dent cause.  The  attacks  of  cerebral  congestion  became  more  severe,  but 
were  still  of  short  duration. 

In  March,  1832,  the  first  serious  attack  occurred  ;  it  was  ushered  in  by  an 
abundant  discharge  of  urine  with  notable  digestive  disorder,  and  was  after- 
wards marked  by  violent  spasms  and  constant  giddiness,  which  did  not  allow 
the  least  motion  of  the  head  without  loss  of  consciousness.  Venesection  and 
leeches  were  had  recourse  to,  with  marked  increase  of  the  agitation  and 
other  symptoms.  Blisters  and  a  seton  in  the  nucha  were  followed  by  mo- 
mentary relief;  but  similar  attacks  soon  recurred. 

In  1833,  the  patient  experienced  much  dread  of  the  cholera ;  he  had  symp- 
toms of  hypochondriasis,  which  were  attributed  to  fear,  and  completely  lost 
his  hearing  on  the  right  side.  In  November,  he  was  bled  in  the  foot,  and 
injections  of  vapor  and  fluid  into  the  ears  were  practised  without  benefit. 
Russian  and  Egyptian  baths  were  used ;  immediately  afterwards,  several 
violent  attacks  occurred,  exactly  similar  to  those  before  suffered.  A  severe 
regimen  was  now  ordered,  together  with  a  large  issue  in  the  nucha  ;  no 
benefit  resulted.  A  venereal  taint  was  now  suspected  by  Recamier,  and  mer- 
curial baths  ordered  without  any  eff"ects  worthy  of  notice.  The  attacks  w«-e 
now  supposed  to  be  periodical,  and  sulphate  of  quinine  was  ordered ;  but  on 
the  third  day  of  this  new  treatment,  a  still  more  serious  attack  occurred,  and 
Marjolin  and  Baudelocque  were  consulted.  Fresh  issues  were  made  in  the 
nucha,  and  mercurial  pills  and  decoction  of  sarsaparilla  were  ordered.  During 
three  months  little  change  occurred.  There  was  violent  pain  in  the  right 
shoulder,  with  an  eruption  in  the  neck. 

In  the  spring  of  1834,  a  slight  improvement  took  place,  which  lasted  two 
months,  after  which,  the  same  attacks  returned  with  increased  frequency  and 
severity.  Valerian  and  belladonna  were  now  prescribed  without  benefit.  In 
the  spring  of  1835,  another  remission  in  the  symptoms  took  place;  but  at 
the  end  of  the  summer,  the  same  accidents  recommenced. 

When  I  saw  the  patient,  his  last  attack  had  continued  upwards  of  a 
month  almost  without  remission  ;  his  emaciation  and  pallidity  were  striking ; 
he  lay  on  his  back  quite  motionless,  not  daring  to  lift  his  head  from  the 
pillow,  or  even  to  turn  from  right  to  left ;  on  the  least  attempt  at  motion  all 
things  around  him  seemed  to  turn  at  the  same  time  that  he  turned  with 


242  CAUSES    OF    SPEEMATORRHCEA. 

them,  and  the  room  appeared  to  sink  with  him;  his  cephalalgia  was  intense 
and  constant,  and  especially  felt  in  the  region  of  the  right  ear;  the  corre- 
sponding temporal  region  was  more  sensitive  than  the  other,  and  the  mouth 
was  drawn  to  the  opposite  side  when  his  lips  were  in  motion.  There  was 
constant  stiffness  of  the  neck  ;  he  was  unable  to  bear  the  least  light  or  noise, 
and  even  a  slight  motion  of  the  air  increased  his  irritability,  and  caused 
serious  symptoms.  His  pulse  was  feeble  and  remarkably  slow  ;  his  urine 
passed  abundantly,  was  muddy,  and  deposited  much  sediment,  containing 
phosphate  of  lime,  with  a  thin  mucus  uniformly  mixed,  and  a  denser  de- 
posit which  occupied  the  lower  layer. 

It  seemed  evident  that  this  deposit  contained  semen  in  abundance, 
although  I  was  unable  to  satisfy  myself  completely  of  the  presence  of  sper- 
matorrhoea, on  account  of  the  quantity  of  urinary  salts  present.  The 
patient  asserted,  that  several  of  his  most  severe  attacks  had  come  on  imme- 
diately after  abundant  nocturnal  pollutions,  and  that  he  always  felt  worse 
the  day  after  they  had  taken  place.  Still  the  deafness  on  the  right  side,  the 
pain  in  the  neighborhood  of  the  right  ear,  and  the  deviation  of  the  mouth 
to  the  opposite  side,  seemed  to  indicate  a  chronic  affection  of  the  right  in- 
ternal ear,  which  probably  had  extended  to  the  membranes  of  the  brain  in 
the  neighborhood.  On  the  other  hand,  both  the  patient  and  Dr.  Guillemot 
had  noticed  that  every  attack  had  been  preceded  by  an  abundant  secretion 
of  clear  colorless  urine,  with  marked  disorder  in  the  digestive  organs.  I 
still  feaj-ed  that  I  might  be  misled,  by  having  my  mind  preoccupied  with  the 
subject  of  spermatorrhoea,  and  I  therefore,  at  this  time,  declined  to  advise 
cauterization. 

Iced  milk,  however,  I  ordered,  and  it  re-established  the  functions  of  the 
stomach  in  a  short  time,  and  increased  the  patient's  appetite,  which  he  was 
obliged  to  satisfy  frequently  under  the  penalty  of  again  suffering  from  cere- 
bral symptoms.  Camphor  was  insupportable  on  account  of  its  influence  on 
the  head,  and  opiate  enemata  produced  constipation.  Syrup  of  uymphea, 
however,  had  a  better  effect.  After  its  use  the  nocturnal  pollutions 
became  more  rare,  and  the  urine,  after  several  variations,  at  length  con- 
tinued perfectly  transparent  (excepting  on  the  days  following  nocturnal 
pollutions),  during  forty  days.  By  degrees,  the  severe  attacks  became  less 
frequent,  and  the  patient  at  last  passed  two  months  without  experiencing 
ai%  :  his  deafness  was  less  complete  ;  his  attacks  of  giddiness  ceased,  and 
at  length  he  had  resumed  his  ordinary  diet,  and  thought  himself  cured, 
when  in  the  middle  of  March,  1836,  his  nocturnal  pollutions  again  became 
more  frequent ;  the  urine  constantly  contained  an  abundant  spermatic  de- 
posit ;  his  digestion  grew  difficult,  and  with  the  symptoms  of  gastric  derange- 
ment, the  giddiness  and  cephalalgia  returned.  Decoction  of  nymphea  in  in- 
jections, and  the  presence  of  a  catheter  in  the  urethra  for  an  hour  or  two  at  a 
time,  caused  these  nocturnal  and  diurnal  pollutions  to  diminish  considerably, 
but  the  coincidence  of  new  disorders  accompanying  the  return  of  the  pollu- 
tions, left  no  doubt  as  to  the  origin  of  the  disease,  and  I  therefore  advised 
cauterization.  This  was  performed  some  time  afterwards,  and  still  later,  I 
used  acupuncture. 

These  means  produced  a  profound  and  lasting  change  in  the  functions  of 
the  spermatic  organs  ;  for,  from  this  time,  the  nocturnal  pollutions  became 
more  and  more  rare,  and  the  urine  rarely  contained  either  spermatic  deposit 
or^  mucous  cloud.  The  other  symptoms  also  gradually  diminished  from 
this  period,  clearly  showing  that  they  arose  from  involuntary  seminal  dis- 


CONGENITAL    PEEDISPOSITION.  243 

charges.  The  attacks  of  giddiness  disappeared  so  completely,  that  M.  M- 


in  travelling  through  Switzerland  shortly  after,  was  able  to  pass  on  a  mule 
along  narrow  precipices,  and  on  the  brink  of  torrents,  without  suffering  the 
least  inconvenience. 

M.  M being  convinced  of  the  return  of  all  his  functions,  has  married, 

and  became  a  father  a  few  mouths  since. 

From  the  conclusion  of  this  case,  it  is  impossible  to  doubt  the  true 
cause  of  the  gastric  and  cerebral  disorder,  and  it  is  evident,  that 
their  habitual  coincidence  was  owing  to  their  arising  from  the  same 
cause.  The  frequent  intermittences  of  the  disorder  are  not  wonder- 
ful after  the  cases  I  have  already  related,  besides,  during  these  inter- 
vals of  a  month  or  two  at  a  time,  the  health  was  never  perfectly 
re-established.  The  patient  was  only  less  ill  than  usual.  Before 
having  severe  attacks,  too,  the  patient  had  suffered  from  slighter 
ones,  to  which  he  paid  no  attention,  but  which  only  differed  from 
those  which  occurred  afterwards  in  their  intensity  and  duration. 

M.  M had  complained  for  a  long  time  of  dull  and  wandering 

pains  in  his  testicles,  painful  erections,  and  frequent  debilitating 
nocturnal  pollutions.  If,  therefore,  his  medical  attendants  had  paid 
attention  to  these  symptoms,  they  must  soon  have  discovered  the 
cause  of  his  disorder. 

It  was  impossible  to  mistake  the  influence  of  blennorrhagia  in  ex- 
citing these  nocturnal  and  diurnal  pollutions,  and  I  did  not  seek 
any  other  cause;    but  Dr.  Guillemot  sent  me  some  very  judicious 

observations,  which  I  must  mention   here.     M.  M 's  father  was 

always  an  invalid  ;  he  was  subject  to  frequent  and  obstinate  catarrhs  ; 
his  appetite  was  irregular  and  his  stomach  very  inactive.  The  state 
of  his  digestion,  too,  exercised  great  influence  over  his  character. 
All  his  family  noticed  the  analogy  between  his  symptoms  and  those 
of  his  son. 

M.  M has  also  a  brother  who  resembles  him  physically  as  well 

as  morally,  and  who  suffers  from  frequent'  but  less  severe  attacks  of 
giddiness.  He  is  also  subject  to  nocturnal  pollutions,  especially 
when  travelling,  and  Dr.  Guillemot  has  often  found  traces  of  sper- 
matic deposit  in  his  urine.  He  is  frequently  constipated,  and  passes 
a  certain  quantity  of  semen  during  his  efforts  at  stool.  He  is  subject 
also  to  eruptions  on  the  glans  and  prepuce.  For  these  symptoms 
he  has  quite  recently  consulted  me.  The  similarity  of  these  cir- 
cumstances recurring  in  M.  M 's  father  and  brother  is  worthy 

of  notice;  indeed,  there  is  no  reason  why  the  genital  organs  should 
not  partake  of  the  family  resemblances,  that  exist  in  features,  height, 
temperament,  &c. 

I  think,  therefore,  that  in  this  case  the  involuntary  discharges, 
and  the  serious  disorder  to  which  they  gave  rise,  depended  more  on 
hereditary  predisposition  than  on  the  blennorrhagia. 

The  following  is  a  very  remarkable  circumstance  of  the  same  kind, 
which  came  under  my  notice  in  1830. 


244  CAUSES    OF    SPERMATOREHGEA. 

CASE  LXII. 
Nochirnal  and  diurnal  pollutions  occurring  in  three  hrothers. 

In  1822,  M.  C ,  aet.  nineteen,  suffered  from  frequent  nocturnal  pollu- 
tions, although  he  had  frequent  sexual  intercourse.  One  night  on  awaking 
he  endeavored  to  prevent  ejaculation  from  taking  place,  by  firm  pressure  on 
the  bed ;  he  succeeded ;  but  the  nest  morning,  without  any  other  evident 
cause,  the  passage  of  urine  was  painful ;  the  second  day  the  pain  in  the 
urethra  increased;  the  patient  had  discharge,  fever,  dysuria,  and  even 
strangury.  These  symptoms  lasted  a  month  and  more,  their  severity  being, 
however,  diminished  by  demulcent  drinks,  local  and  general  baths,  and  a 
strict  regimen.  Before  the  patient  was  quite  well  he  attempted  coitus,  which 
was  accompanied  with  severe  pain  in  the  urethra.  A  little  while  after  there 
was  abundant  deposit  in  the  urine. 

In  1823,  after  a  very  tiring  walk,  this  patient  experienced  a  lively 
burning  in  the  urethra  during  the  passage  of  urine.  The  discharge,  too, 
returned,  but  passed  off  without'  any  treatment.  During  the  five  years 
following,  although  he  was  strictly  continent,  he  suffered  from  constant 
burning  in  the  urethra,  with  from  time  to  time  dysuria,  pain  in  the  loins, 
and  abundant  deposit  in  the  urine. 

In  1829,  he  was  in  a  state  of  profound  melancholy  and  depression  ;  he 
suffered  from  difficulty  of  breathing,  a  sense  of  weight  at  the  epigastrium, 
anorexia,  frequent  liquid  stools,  and  heavy  pain  in  the  lumbar  and  hypo- 
gastric regions.  Whenever  he  went  to  stool,  a  considerable  discharge  of 
watery  semen  took  place,  and  the  same  thing  happened  frequently  during 
the  emission  of  the  last  drops  of  urine,  as  well  as  after  he  had  experienced 
the  least  venereal  excitement,  although  he  had  not  had  erection.  The 
prostate  was  not  enlarged,  but  painful  on  pressure. 

This  patient's  elder  brother,  set.  twenty-five,  of  robust  constitution  and 
remarkable  muscular  strength,  possessed  active  virility  at  the  age  of  nine- 
teen, when  he  had  daily  meetings  with  a  female  whom  he  endeavored  to 
seduce,  often  renewing  his  attempts  three  or  four  times  in  a  few  hours.  At 
first,  obstacles  only  arose  from  the  pain  caused,  and  the  unfavorable  cir- 
cumstances that  accompanied  \hese  meetings,  but  after  a  time  his  erections 
became  incomplete,  ejaculation  took  place  very  rapidly,  and  at  last  took 
place  on  the  first  approaches.  Afterwards  he  addressed  himself  to  other 
females,  but  then  he  perceived  that  his  erections  were  incomplete,  rare,  and 
of  short  duration ;  he  experienced  frequent  and  almost  passive  nocturnal 
pollutions,  with  pain  in  the  testicles  and  spermatic  cords,  and  at  last,  invo- 
luntary discharges  during  efforts  at  stool ;  his  health,  however,  was  not 
much  disordered. 

The  younger  brother,  aet.  nineteen,  also  suffered  from  nocturnal  pollutions 
without  erection,  involuntary  discharges  at  stool  during  the  emission  of 
urine,  and  even  while  in  company  with  a  female.  These  he  attributed  to 
considerable  ungratified  venereal  excitement,  which  he  had  experienced 
daily  for  a  long  time  together. 

The  coincidence  of  nocturnal  and  diurnal  pollutions  in  three 
brothers,  the  eldest  eet.  twenty-seven,  the  youngest  nineteen,  is 
remarkable  enough; — all  three  being  strong  and  well  made,  ,It  is 
worthy  of  note  also  that  the  gravity  of  the  symptoms  was  exactly  pro- 


CONGENITAL    PREDISPOSITION.  245 

portioned  to  the  age  of  the  individuals,  and  consequently  to  the  dura- 
tion of  their  disease ;  for  it  seemed  to  have  commenced  in  each  case 
at  about  the  same  age. 

The  causes  which  favored  the  development  of  the  disease  in  these 
three  brothers  were  too  slight  in  each  case  not  to  require  the  hypo- 
thesis of  congenital  disposition  to  account  for  its  appearance.  Cases 
of  this  kind  are  rare,  but  those  above  related  are  sufficiently  charac- 
teristic to  leave  no  doubt  of  the  possibility  of  hereditary  predispo- 
sition to  involuntary  discharges  existing  without  any  sign  in  the 
genital  organs  denoting  its  presence. 

Congenital  increased  Nervous  Susceptihility . — I  have  met  with  a 
considerable  number  of  patients  in  whom  involuntary  discharges  were 
referable  rather  to  an  originally  excited  sensibility  of  the  genital 
organs,  than  to  congenital  relaxation.  None  of  these  patients  had 
been  exposed  to  the  influence  of  any  cause  sufficient  to  account  for 
the  occurrence  of  spermatorrhoea. 

In  general  such  patients  were  of  sickly  constitution,  and  more  or 
less  marked  nervous  temperament ;  they  had  been  delicate  from  child- 
hood, and  subject  to  various  spasmodic  disorders.  Some  of  them 
presented  involuntary  twitching  of  the  muscles  of  the  face,  hesitation 
of  the  speech,  &c.  ;  their  imagination  was  active,  and  their  moral 
and  physical  sensibility  very  acute.  They  were  very  restless,  and 
bore  contradiction,  or  mental  excitement,  badly. 

In  childhood  they  presented  local  symptoms,  which  indicated 
peculiar  susceptibility  of  the  urinary  organs,  every  impression  of  fear 
or  anxiety  showing  itself  in  this  direction.  What  would  have  pro- 
duced shuddering,  or  palpitation  in  other  children,  in  them  caused  a 
secretion  of  clear  watery  urine,  which  they  were  obliged  to  discharge 
frequently ;  a  sense  of  constriction  of  the  hypogastrium,  and  a  sense 
of  titillation  generally  accompanied  its  discharge.  This  condition  of 
the  urinary  organs  continued  more  or  less  severe  in  all  the  cases 
until  after  puberty,  when  it  became  joined  with  other  symptoms. 
One  of  these  patients  one  day  experienced  at  the  age  of  sixteen  a  fit 
of  irritability  and  impatience,  which,  however,  he  succeeded  in  re- 
pressing ;  and  he  then  felt  sudden  and  impetuous  desire  of  micturi- 
tion :  whilst  emptying  his  bladder  he  perceived  a  large  quantity  of 
pure  semen  discharged  with  the  last  drops  of  urine.  This  occurrence 
was  the  forerunner  of  nocturnal  and  diurnal  pollutions,  which  at  the 
age  of  twenty-seven  had  entirely  ruined  his  health.  Another,  at  the 
moment  of  competition  for  a  college  prize,  was  unable  to  find  an  ex- 
pression he  wanted :  at  the  same  time  he  felt  a  want  to  make  water, 
which  he  resisted  by  firmly  crossing  his  legs ;  but  his  impatience 
increased,  and  he  shortly  experienced  an  abundant  emission  without 
either  erection  or  pleasure.  A  third  patient  suffered  in  the  same 
way  under  similar  circumstances  ;  he  saw  the  moment  approach  for 
sending  in  his  thesis  ;  the  more  he  endeavored  to  hurry,  the  less  freely 
his  expressions  flowed  ;  at  length,  on  hearing  the  clock  strike,  he 
suffered  from  so  great  mental  disorder  that  he  nearly  fainted  :  at  this 
16 


24:6  CAUSES    OF    SPERMATOERHCEA. 

moment  emission  took  place.  A  fourth  having  mounted  on  a  high 
gutter  of  a  house  to  take  some  sparrows'  nests,  looked  down  into  the 
court  below,  and  was  suddenly  seized  with  such  terror  that  he  fainted; 
on  recovering  and  escaping  from  his  dangerous  situation  he  found  that 
he  had  had  an  abundant  seminal  emission.  The  same  circumstance 
occurred  to  a  fifth,  who,  in  descending  a  ladder,  missed  his  footing 
and  fell.  Another  patient  told  me  that  if  he  looked  down  from  a 
height,  or  only  fancied  himself  on  the  brink  of  a  precipice,  he  felt 
a  sense  of  contraction  in  the  genital  organs,  which  passed  rapidly 
to  the  base  of  the  penis,  and  ended  by  causing  emission.  The  motion 
of  a  swing  produced  the  same  effects  in  a  seventh. 

Almost  all  these  excitable  persons  were  exposed  to  erection,  and 
even  to  pollutions  whenever  they  rode  on  horseback. 

Although  all  these  involuntary  discharges  were  caused  by  extra- 
ordinary circumstances,  I  should  not  have  paid  much  attention  to 
them  if  they  had  not  been  followed  by  nocturnal  and  diurnal  pollu- 
tions, which  the  most  trifling  circumstances  rendered  very  serious. 
The  disease,  however,  did  not  always  put  on  a  serious  aspect  imme- 
diately after  these  singular  accidents ;  very  often,  indeed,  it  only 
injured  the  patient's  health  long  afterwards  ;  but  as  its  gravity  could 
not  be  explained  by  any  occasional  cause,  I  feel  myself  compelled  to 
admit  the  existence  of  a  congenital  increased  nervous  susceptibility 
of  the  genito-urinary  organs.  Everything  indicates,  in  fact,  that  the 
organs  of  these  patients  were  rather  excitable  than  weak  and  relaxed ; 
and  this  condition  was  congenital  because  manifested  from  the  earliest 
infancy.  This  excessive  sensibility  of  the  genital  organs  is,  however, 
not  always  preceded  by  a  similar  condition  of  the  urinary  apparatus. 

In  all  these  cases,  tonics  and  excitants  always  produced  bad 
effects  ;  proving  that  the  genital  organs  were  not  suffering  from 
atony. 

Long-continued  Continence. — I  have  already  shown  the  vast  ad- 
vantage of  chaste  habits,  strict  principles,  and  moderate  desires ;  I 
have  now  to  point  out  the  inconveniences  resulting  in  certain  cases 
from  absolute  and  long-continued  abstinence  from  sexual  intercourse. 
The  effects  produced  by  complete  privation  afford  the  most  certain 
evidence  of  the  original  strength  or  debility  of  the  genital  organs. 
If  they  are  powerful,  such  privation  proves  a  kind  of  torture  which 
may  induce  the  most  serious  abuses,  or  disorder  in  ainhe  functions; 
if  irritable,  prolonged  abstinence  causes  abundant  and  frequent 
nocturnal  pollutions  ;  if  weak  and  little  developed,  such  privation  is 
not  painful ;  the  pollutions  are  rare  and  in  small  quantity  at  first,  but 
still  they  produce  a  serious  effect,  and  after  a  time  they  become  more 
and  more  severe  and  difficult  of  cure. 

These  signs  of  energy,  irritability,  or  weakness  in  the  genital 
organs,  are  more  certain  than  those  drawn  from  their  external 
appearance. 

The  patients  of  whom  I  am  about  to  speak  are  all  remarkable  for 
the  facility  with  which  they  support  privation  from  sexual  intercourse. 


CONGENITAL    PEEDISPOSTTION.  247 

Their  lives  are  exemplary  in  all  respects ;  not  only  have  tliey  never 
committed  excesses  or  practised  abuse,  but  for  the  most  part  they  have 
never  even  had  any  relations  with  the  opposite  sex.  In  these  cases 
the  temptation  is  so  slight  that  to  conquer  it  is  not  any  great  merit. 
Such  constant  and  easy  continence  is  an  unfavorable  sign  when 
considered  in  reference  to  the  powers  of  the  genital  organs ;  and  we 
should  much  deceive  ourselves  if  we  adopted,  without  examination, 
the  explanation  the  patients  give  of  their  conduct.  They  generally 
attribute  their  continence  to  strict  morality,  to  religious  principles 
inculcated  in  early  infancy,  or  to  the  effects  of  good  example;  they 
omit  altogether  to  mention  the  little  desire  they  have  had  to  combat. 
Buf  when  such  patients  wish  to  break  their  long  and  easy  continence, 
they  find  themselves  completely  unable;  not  on  one  occasion  only, 
but  habitually ;  not  under  unfavoi-able  circumstances,  but  during 
many  years  of  marriage.  Such  a  state  of  things  during  the  period 
of  the  greatest  virility  completely  explains  the  ease  with  which 
they  maintained  their  former  long  continence.  Most  of  these  pa- 
tients, too,  feel  a  strange  presentment  of  the  catastrophe  which 
awaits  them.  They  have  a  suspicion  of  their  weakness,  and  hence 
they  manifest  an  instinctive  repugnance  to  marriage,  and  hesitate 
long  before  they  are  able  to  make  up  their  minds  to  enter  that  state. 

A  great  facility,  then,  of  supporting  absolute  continence,  ought 
to  lead  us  to  suspect  want  of  power  in  the  genital  organs  ;  as  well 
as  diurnal  pollutions  when  nocturnal  ones  do  not  occur,  because  the 
continued  presence  of  semen  will  stimulate  the  least  powerful  organs 
into  occasional  action. 

Let  us  now  see  what  are  the  effects  of  such  long  continence,  es- 
pecially in  these  weak  individuals.  If  fatigue  be  hurtful  to  all 
organs,  so  moderate  exercise  is  necessary  to  them  as  soon  as  they 
are  in  a  condition  to  act.  The  generative  organs  are  not  beyond 
the  influence  of  this  general  law.  All  surgeons  admit  that  prolonged 
inaction  produces  the  same  effects  on  the  genital  organs  as  on  any 
other :  that  is  to  say,  that  it  diminishes  their  energy  and  activity. 
The  inactivity  of  these  organs  in  children  and  eunuchs  arises  from 
the  non-secretion  of  semen;  no  pollutions  can  therefore  arise  in  such 
cases,  and  the  health  does  not  become  disordered.  On  the  contrary, 
in  the  unmutilated  adult,  want  of  power  can  only  be  attributed  to 
very  serious  diurnal  pollutions,  often  very  difficult  of  cure.  As  soon 
as  the  evolution  of  the  genital  organs  commences,  the  testicles  begin 
to  act ;  if  their  structure  be  not  accidentally  injured,  they  continue 
to  secrete  until  a  very  advanced  age.  This  secretion,  it  is  true,  may 
be  diminished  by  the  absence  of  all  excitement,  direct  or  indirect,  or 
by  momentary  weakening  of  the  system,  or  by  the  special  action  of 
certain  medicines ;  but  it  never  ceases  entirely  from  the  age  of  pu- 
berty to  the  commencement  of  old  age.  Hence  results  an  evident 
deduction,  viz. :  that  in  the  absence  of  all  voluntary  evacuation  the 
seminal  vesicles  must  become  filled  more  or  less  rapidly,  and  after  a 
time  must  become  distended ;  so  that  if  the  secretion  be  not  evacu- 


248  CAUSES    OF    SPERMATOREH(EA. 

ated  in  quantity  in  an  open  and  sudden  manner,  it  must  escape  by 
degrees  at  periods  more  or  less  close,  and  under  circumstances  which 
render  this  evacuation  difficult  to  be  ascertained.  In  other  words, 
if  nocturnal  pollutions  do  not  occasionally  occur,  it  is  because  diur- 
nal ones  exist. 

From  the  numerous  cases  I  have  related,  it  is  evident  how  slow 
and  insidious  the  progress  of  this  disease  may  be,  and  it  is  remark- 
able that  those  who  have  fallen  into  the  most  deplorable  condition, 
and  whose  cure  has  been  most  difficult,  have  been  precisely  such  as 
had  supported  the  disease  longest  without  suffering  much. 

In  studying  the  cases  attentively,  it  becomes  evident  that  the  dis- 
ease commences  by  nocturnal  pollutions,  accompanied  with  lascivious 
dreams,  energetic  erections,  and  a  lively  sense  of  pleasure.  But  this 
orgasm  diminishes  by  degrees,  and  the  emissions  at  last  take  place 
without  erection  or  sensation  ;  such  nocturnal  pollutions  become 
more  rare,  and  sometimes  cease  entirely,  and  then  the  health  of  the 
patients  becomes  seriously  and  rapidly  affected,  much  to  their 
astonishment,  as  they  have  no  suspicion  that  diurnal  pollutions  have 
been  added  to  the  nocturnal  ones,  and  at  last  have  entirely  taken 
their  place. 

By  reflecting  on  the  succession  of  the  phenomena  in  individuals 
who  have  done  nothing  to  aggravate  their  condition  ;  and  taking 
into  the  consideration  the  salutary  effects  which  sexual  intercourse 
produced  in  many  of  the  cases  that  have  come  under  ray  notice  (see 
case  fifty-six),  it  is  impossible  not  to  admit  that  prolonged  inaction  of 
the  genital  organs  diminishes  the  tonic  resistance  of  the  ejaculatory 
ducts,  disorders  their  sensibility,  and  perverts  their  functions  without 
being  able  to  prevent  the  formation  of  semen  by  the  testicles,  or  its 
passage  into  the  seminal  vesicles.  Absolute  continence,  therefore, 
renders  the  expulsion  of  semen  more  and  more  easy  in  these  cases 
without  diminishing  its  secretion  in  an  equal  proportion. 

The  striking  and  numerous  cases  of  this  kind  that  I  have  met  with, 
leave  no  doubt  on  my  mind  as  to  the  true  cause  of  the  deceitful  calm 
of  the  genital  system.  The  erections  and  the  desires  undoubtedly 
cease  ;  impotence  is  established ;  the  organs  no  longer  give  the  least 
sign  of  activity  ;  nothing  can  remove  their  torpidity  ;  all  this  is  incon- 
trovertible ;  but  this  condition  is  far  from  one  of  rest,  especially  of 
reparative  rest ;  no  advantage  to  the  economy  can  result  from  it,  in 
whatever  manner  the  other  functions  may  be  performed  ;  it  is  truly 
a  pathological  state  ;  and  it  may  exist  long  without  appearing  seri- 
ous or  sensibly  affecting  the  constitution.  But  it  becomes  aggra- 
vated with  the  prolongation  of  the  continence,  and  grows  daily  more 
difficult  of  cure. 

The  good  health  of  such  patients  is  only  apparent ;  the  least  cir- 
cumstances disorder  it,  and  what  they  suffer  is  unsuspected  ;  their 
parents,  their  most  intimate  friends,  are  ignorant  of  the  cause  of  the 
various  disorders  they  complain  of ;  the  medical  man  who  possesses 
their  confidence  is  not  better  informed,  because  the   patients  them- 


CONGENITAL    PREDISPOSITION.  249 

selves  do  not  suspect  it ;  thus  their  indispositions  are  set  down  to 
ennui,  tendency  to  melancholy,  or  hypochondriasis.  When  their 
diseases  become  more  serious,  their  constitutions  are  said  to  be  deli- 
cate, impressionable,  or  unhealthy,  or  they  are  considered  malades 
imaginaires.  They  are  told  that  they  pay  too  much  attention  to 
themselves,  or  that  they  have  fondness  for  medicines.  Medical  men 
in  large  practice  get  tired  of  hearing  their  long  series  of  inexplica- 
ble complaints,  and  get  rid  of  them  by  advising  travelling,  or  change 
of  air.  Charlatans  rob  them  ;  officious  friends  advise  marriage,  or 
occupation  to  fill  the  void  in  their  existence  ;  every  one  blames,  be- 
cause no  one  understands  them.  Incapable  of  all  serious  occupa- 
tion or  deep  affection,  they  grow  discontented  with  themselves  and 
still  more  so  with  others ;  absorbed  by  one  sole  thought,  they  return 
unceasingly  to  themselves  to  seek  the  cause  of  their  condition,  and 
soon  become  misanthropical. 

When  the  disease  has  arrived  at  this  point,  it  must  make  progress, 
because  the  normal  exercise  of  the  organs  is  indispensable  to  give 
them  tone  and  to  put  an  end  to  the  involuntary  seminal  discharges ; 
but  these  no  longer  permit  the  erectile  tissues  to  pass  out  of  their 
torpidity.  We  must,  therefore,  commence  by  arresting  these  pollu- 
tions ;  but  when  they  have  become  diurnal  their  existence  is  easily 
mistaken,  and  their  cure  is  more  difficult  in  proportion  as  the  period 
of  inaction  has  been  more  prolonged. 

From  these  facts  it  results  that  the  least  excitable  and  the  most 
continent  and  timid  individuals  are  precisely  those  for  whom  habi- 
tual continued  continence  is  most  injurious  ;  they  endure  it  with  less 
immediate  inconvenience  than  others  ;  and  although  any  excess 
would  be  very  prejudicial  to  them,  absolute  privation  possesses  the 
greatest  dangers.  In  fact,  natural  moderate  exercise  can  alone 
give  to  their  organs  sufficient  energy,  and  sufficiently  regular  habits 
to  arrest  nocturnal  pollutions,  and  to  prevent  the  occurrence  of 
diurnal  ones.  No  one  would  think  of  depriving  a  delicate  child  of 
exercise  simply  because  he  shows  less  disposition  for  it  than  his  com- 
panions. Every  one,  on  the  contrary,  would  understand  that  it  is 
the  only  means  by  which  his  weak  constitution  can  be  strengthened, 
if  not  rendered  hardy.  The  same  reasoning  holds  good  in  respect 
to  the  cases  under  consideration. 

General  Review  of  the  Causes  of  Spermatorrhcea, — It  has 
been  seen  that  the  causes  of  involuntary  seminal  discharges  are  very 
numerous,  and  that  their  mode  of  action  varies  much.  Hippocrates 
wrote  only  of  venereal  excesses.  Tissot  and  his  successors  added 
masturbation — the  incompleteness  of  this  list  is  evident.  These  two 
causes  were  supposed  to  act  invariably  in  the  same  manner ;  whereas 
I  have  proved  that  their  influence  varies  in  different  individuals,  and 
even  in  the  same  individual  at  different  times.  All  pollutions,  too, 
whether  nocturnal  or  diurnal,  were  referred  to  relaxation  of  the 
genital  organs ;  but  I  have  shown  that  a  very  opposite  condition  pro- 


250  CAUSES    OF    SPEEMATOREHCEA. 

duces  the  same  effects;  indeed,  that  this  supposed  relaxation  seldom 
exists  alone,  especially  under  the  circumstances  stated. 

I  will  now  briefly  recapitulate  these  causes.  The  first  I  considered 
was  hlennorrhagia — tracing  the  inflammation  from  the  orifice  of  the 
glans  penis,  and  considering  all  the  changes  produced  by  it  in  the 
tissues.  Secondly,  I  spoke  of  cutaneous  affections,  pointing  out  the 
mode  in  which,  by  propagation  of  the  cutaneous  irritation  through 
its  continuity  with  the  mucous  lining  of  the  urethra,  involuntary  se- 
minal discharges  arise.  Thirdly,  I  considered  the  influence  of  the 
rectum.  This  I  divided  into  two  kinds  :  the  one  being  mechanical, 
arising  from  an  obstacle  to  defecation  or  from  constipation,  the 
other  a  vital  action,  producing  its  effects  by  the  extension  of  irri- 
tation from  the  rectum  to  the  prostate  and  seminal  vesicles.  The 
fourth  cause  of  which  I  treated,  was  abuse.  Here  I  pointed  out  the 
various  causes  of  abuse,  their  importance,  and  the  varieties  of  abuses. 
On  these  points  I  laid  considerable  stress,  on  account  of  their  im- 
portance to  the  well  being  of  the  human  race  ;  I  also  pointedout 
the  effects  of  abuses,  and  the  means  to  be  taken  to  prevent  them. 
The  fifth  cause  that  came  under  my  notice  consisted  of  venereal  ex- 
cesses, and  here  I  showed  the  circumstances  which  constitute  ex- 
cesses, and  the  conditions  in  which  slight  sexual  intercourse  may  be 
injurious.  I  showed,  also,  that  factitious  desires  may  arise  and  carry 
intercourse  beyond  the  actual  wants  of  the  system.  The  general 
and  special  effects  of  venereal  excesses  also  occupied  my  attention. 
Sixthly,  I  considered  the  action  of  certain  medicines  inducing  in- 
voluntary seminal  discharges.  I  showed  the  effects  of  astringents, 
purgatives,  and  medicines  which  stimulate  the  urinary  organs,  such 
as  nitrate  of  potass,  &c.  I  also  mentioned  the  action  of  coffee  and 
tea,  when  taken  in  excess.  Seventhly,  the  action  of  the  cerebro- 
spinal system  occupied  my  attention.  I  here  considered  the  action 
of  the  cerebellum  and  spinal  cord.  Eighthly,  I  considered  conge- 
nital j^redisjyosition ;  and  here  malformations  came  under  my  notice, 
with  phimosis,  exuberant  prepuce,  vitiated  secretion  of  sebaceous 
matter,  hereditary  predisposition,  congenital  debility,  &c.  I  also 
passed  rapidly  over  the  symptoms  by  which  debility  of  the  genital 
organs  may  be  recognized,  and  the  conclusions  to  be  drawn  from  in- 
continence of  urine  during  childhood.  I  also  made  a  few  remarks 
on  disorders  of  nervous  susceptibility,  and  on  the  effects  of  con- 
tinence on  cases  in  which  the  genital  organs  are  originally  in  an 
atonic  condition.  I  have,  in  this  first  part  of  my  work,  related 
many  cases — too  many  perhaps  to  suit  the  taste  of  some  readers — 
but  I  found  myself  under  the  necessity  of  treating  the  subject  of 
involuntary  discharges  as  an  entirely  new  one,  and  of  proving  each 
proposition  as  I  proceeded — the  scanty  writings  on  the  subject  that 
have  hitherto  appeared,  being  not  only  useless,  but  worse — full  of 
errors. 


LOCAL    SYMPTOMS.  251 


CHAPTER  XI. 

SYMPTOMS    OF    S  P  E  RM  AT  0  R  R  H  (E  A. 


I  HAVE  hitherto  been  occupied  only  in  considering  the  cause3  of 
spermatorrhoea  ;  its  symptoms  now  claim  more  special  attention. 

A  cursory  glance  at  the  symptoms  of  involuntary  seminal  dis- 
charges is  sufficient  to  show,  that  some  may  be  referred  exclusively 
to  the  genital  organs,  while  others  extend  to  all  the  functions  of  the 
system.  The  first  constitute  the  disease,  the  second  are  only  its 
more  or  less  remote  consequences.  I  divide  the  symptoms,  therefore, 
into  two  great  groups  of  local  and  general  symptoms,  in  order  to 
approximate,  in  their  natural  position,  those  phenomena  which  are 
most  nearly  connected  among  themselves.  Both  divisions  are,  never- 
theless, intimately  connected. 

While  considering  these  symptoms  singly  and  in  order,  I  shall 
avoid  all  those  subtle  divisions  that  have  been  proposed,  into  pollu- 
tions attended  with  erection,  pleasure,  spasmodic  contraction,  &c.  ; 
such  being,  in  my  opinion,  only  useless  complications  of  the  subject. 

LOCAL    SYMPTOMS. 

Nocturnal  Pollutions. — Those  involuntary  discharges  that  take 
place  during  sleep  are  easily  ascertained  ;  but  it  is  not  always  so 
easy  to  appreciate  the  degree  of  importance  to  be  attached  to  them, 
because  they  are  not  all  equally  injurious;  under  some  circumstances 
they  are  even  useful.  The  most  abundant  nocturnal  pollutions  are 
far  from  being  always  the  most  hurtful.  When  they  arise  from  true 
spermatic  plethora,  they  often  relieve  erotic  excitement,  with  its 
accompanying  agitation,  anxiety,  uneasiness,  and  indefinable  trouble 
in  all  the  functions.  They  are  followed  by  a  general  feeling  of 
comfort ;  the  head  becomes  clearer,  the  ideas  more  rapid,  and  the 
motions  more  nimble;  there  is  more  inclination  to  amusement,  and 
to  every  kind  of  occupation.  I  admit  that  nocturnal  pollutions  do 
not  often  produce  such  good  efi"ects,  but  then  they  are  not  often  the 
result  of  spermatic  plethora  ;  they  may,  too,  easily  lose  their  char- 
acter, so  that  habit  alone  tends  to  make  them  more  and  more  fre- 
quent. In  the  greater  number  of  cases,  however,  these  evacuations 
are  of  very  little  importance. 

But  this  state  of  excitement  is  too  violent  to  last  long  :  by  degrees 
the  organs  become  fatigued.     Deprived  of  their  natural  functions, 


252  SYMPTOMS    OF    SPERMATGRRHCEA. 

and  consequently,  being  unstrengthened  by  regular  exercise,  they 
may  at  last  fall  into  a  state  of  atony,  or  the  seminal  vesicles  may 
preserve  the  habit  of  contracting,  under  the  influence  of  slight  or 
indirect  excitement.  The  evacuations  now  produce  the  effects  quite 
opposite  to  those  experienced  in  the  beginning.  There  are,  on  wak- 
ing, feelings  of  discontent,  idleness,  weight  in  the  head,  disorder  in 
the  ideas,  &c.,  but  this  condition  passes  off  in  the  course  of  the  day, 
and  the  patient  is  quite  well  on  the  following  morning,  if  no  further 
emission  take  place.  After  a  time,  these  effects  become  more  serious 
and  lasting,  and  two  or  three  days  are  required  to  remove  them 
completely.  There  is,  however,  no  disease  as  yet,  because  the  eco- 
nomy is  not  as  yet  permanently  disordered;  but  there  is  a  degree  of 
instability  in  the  patient's  health,  a  valetudinary  condition,  the  pro- 
gress of  which  it  is  necessary  to  arrest. 

In  these  simple  and  early  cases  moderate  coitus  is  useful ;  it  gives 
tone  to  the  organs,  and  breaks  off  the  habit  of  involuntary  emissions. 
At  a  later  period  coitus  has  its  dangers. 

When  nocturnal  pollutions  are  excited  by  abuse,  by  venereal 
excesses,  or  by  the  irritation  of  ascarides,  they  frequently  produce 
serious  disorders  soon  after  their  appearance,  and  the  disease  rapidly 
progresses.  By  degrees  all  the  phenomena  of  excitement  which 
preceded  or  accompanied  the  crisis,  disappear  entirely ;  emission 
occurs  without  dreams,  erections,  pleasure,  or,  indeed,  any  particular 
sensations  ;  so  that  the  patients  only  discover  what  has  taken  place 
by  finding  the  marks  on  their  linen  when  they  awake.  At  the  same 
time,  the  seminal  fluid  loses  its  consistence,  color,  smell,  and  even  sper- 
matozoa by  degrees,  and  more  and  more  resembles  mucus  or  prostatic 
fluid.  It  is  impossible  to  doubt  its  identity,  however ;  the  changes 
take  place  slowly,  and  frequently  patients  are  able  to  follow  their 
progress.  These  watery  evacuations  are  followed  by  similar  but 
more  violent  effects  ;  besides,  the  seminal  vesicles  alone  can  furnish 
so  abundant  a  discharge  of  viscid  matter.  The  emission  is  sudden,  the 
patients  never  having  a  constant  seminal  discharge.  A  similar  evacu- 
ation does  not  always  take  place  every  night,  though  sometimes  dis- 
charges may  happen  frequently  in  one  night ;  and  this  the  patients 
are  easily  able  to  ascertain,  because  their  sleep  is  light  and  broken. 
As  to  the  absence  of  erection  during  these  discharges,  it  cannot  be 
doubted,  as  the  matter  is  found  in  the  hair  around  the  base  of  the 
penis,  in  the  perineum,  and  even  on  the  thigh.  When  it  becomes 
dry  after  flowing  over  the  skin,  it  forms  a  thin,  brilliant  pellicle, 
resembling  the  mark  left  by  the  garden  snail.  Generally,  a  good 
deal  of  this  matter,  too,  is  found  on  the  interior  of  the  prepuce  ; 
sometimes  even  the  prepuce  is  entirely  filled  with  it,  showing  the 
flaccidity  of  the  penis,  and  the  little  energy  of  the  seminal  vesicles. 
This  kind  of  progressive  decrease  in  the  excitement  of  the  genital 
organs,  with  the  corresponding  increased  alteration  in  the  qualities 
of  the  semen,  is  accompanied  with  notable  increase  in  the  severity  of 
the  general  symptoms,  and  in  the  difliculty  of  treating  them. 


LOCAL    SYMPTOMS.  253 

In  nocturnal  pollutions,  and,  indeed,  in  all  involuntary  seminal 
discharges,  the  semen  rarely  undergoes  any  other  alterations  than 
those  of  which  I  have  spoken ;  even  when  the  patients  have  prac- 
tised masturbation  or  coitus  so  furiously  as  to  cause  emissions  of 
blood.  I  have  only  met  with  one  case  in  which  the  pollutions  were 
sanguinolent,  and  that  only  for  a  few  days.  The  semen  is  also  rarely 
purulent  or  sanious,  at  least  during  any  length  of  time,  in  patients 
affected  by  involuntary  discharges ;  such  characters  evince  a  pro- 
found lesion  of  the  spermatic  organs,  which  would  be  soon  followed 
by  death  if  it  continued  in  so  great  intensity.  It  often  happens  that 
ordinary  spermatorrhoea  follows  these  sanguinolent  or  sanious  emis- 
sions ;  but  so  long  as  the  disease  preserves  the  characters  of  a  sim- 
ple inflammation  it  must  be  considered  as  such,  and  treated  accord- 
ingly. The  effects  of  nocturnal  pollutions  are  generally  supposed 
to  be  proportioned  to  their  abundance,  frequency,  and  the  energy 
of  the  phenomena  that  precede  and  accompany  them  :  this  conclu- 
sion is,  however,  extremely  false.  In  all  the  cases  of  nocturnal  pol- 
lutions related  by  authors,  occurring  critically,  and  putting  an  end 
to  alarming  symptoms,  the  discharges  have  been  very  copious,  and 
often  repeated  in  a  single  night.  It  may  easily  be  conceived,  there- 
fore, that  it  is  only  in  an  extreme  state  of  spermatic  plethora  that 
such  frequent  discharges  can  take  place.  But,  putting  aside  these 
exceptional  cases,  we  may  often  be  deceived  as  to  the  importance  of 
nocturnal  pollutions  when  considered  only  with  respect  to  the 
abundance  and  frequency  of  the  discharges  ;  for  the  virile  powers 
vary  much  in  different  individuals,  and  we  have  no  certain  means  of 
establishing  the  relation  between  this  power  and  the  constitutional 
strength  of  the  patient.  Besides,  on  the  other  hand,  it  is  generally 
when  the  pollutions  become  less  frequent  and  abundant  that  they  are 
followed  by  serious  and  long-continued  general  symptoms.  This 
anomaly  is,  however,  only  apparent,  because  the  nocturnal  pollutions 
become  joined  with  diurnal  ones  that  occur  insensibly.  It  is,  there- 
fore, of  importance  to  warn  both  surgeons  and  patients  of  the  errors 
they  commit  daily  in  estimating  the  value  of  nocturnal  pollutions 
by  their  abundance  and  frequency. 

It  is  generally  believed  that  erotic  dreams  excite  nightly  dis- 
charges, and  they  are  consequently  considered  very  dangerous.  But 
the  lascivious  images  that  present  themselves  during  sleep  arise  from 
excitement  of  the  genital  organs  in  the  same  way  as  the  erections 
and  the  contractions  of  the  seminal  vesicles.  These  phenomena  all 
coincide  ;  they  all  arise  from  the  same  cause ;  but  one  does  not  de- 
pend on  the  other. 

Two  kinds  of  these  dreams  may  occur ;  the  one  arising  from  true 
spermatic  plethora,  and  presenting  pleasant  images  unmixed  with  any 
disagreeable  sensation  ;  the  other,  excited  by  irritation  of  the  organs, 
and  mingled  with  filthy  or  disgusting  ideas.  After  a  time  too  these 
dreams  may  degenerate  into  true  nightmare,  accompanied  with  ter- 
rible sensations  and  difficulty  of  respiration,  and  in  the   middle  of 


254  SYMPTOMS    OF    SPERMATOERHCEA. 

the  agitation  the  seminal  emission  takes  place  unaccompanied  by  any 
lascivious  idea  or  voluptuous  sensation.  The  danger  commences  when 
the  erotic  dreams  diminish  in  vigor,  and  their  return  is  one  of  the 
most  certain  signs  of  improvement. 

The  same  thing  may  be  said  of  the  energetic  and  long-continued 
erections,  and  the  active  contractions  that  take  place  under  similar 
circumstances.  The  diminution  of  the  energetic  phenomena  alone 
should  cause  uneasiness,  the  most  debilitating  discharges,  and  those 
most  difficult  of  cure  being  those  that  take  place  most  passively. 
The  more  the  seminal  fluid  too  loses  its  distinctive  characters  and 
becomes  watery,  the  more  hurtful  are  the  effects  of  the  discharges 
on  the  system. 

Diurnal  pollutions  are  distinguished  from  nocturnal  ones  by  their 
taking  place  during  the  waking  state.  They  may  be  divided  into 
two  classes :  those  that  happen  during  defecation,  and  those  that 
occur  during  the  emission  of  urine. 

The  diurnal  pollutions  that  happen  during  defecation  are  more 
easily  discovered  than  those  that  take  place  during  the  emission  of 
urine  ;  they  do  not,  however,  always  constitute  a  disease,  although 
they  can  never  be  critical  or  useful  like  certain  nocturnal  pollutions. 
So  long  as  they  happen  rarely,  and  are  accidental,  the  health  is  not 
injured ;  but  when  they  do  not  cease  on  the  removal  of  the  acci-, 
dental  exciting  cause,  they  incline  to  become  more  and  more  fre- 
quent, and  to  continue  from  habit,  and  after  a  time  constitute  a 
disease  which  may  become  serious  and  obstinate.  The  transitions 
are  sometimes  so  insensible,  that  it  is  difficult  to  establish  fixed  cha- 
racters for  them,  which  shall  be  constantly  applicable  to  practice. 

When  a  robust  individual  has  been  submitted  to  unusual  conti- 
nence, and  to  the  long-continued  motion  of  a  carriage,  he  may  ex- 
perience, after  a  few  days'  travelling,  an  abundant  discharge  of  semen 
during  the  violent  efforts  excited  by  accidental  constipation.  This  is 
not  a  matter  for  much  alarm  ;  all  will  disappear  as  soon  as  the  cause 
is  removed.  But  habitual  and  constant  travelling  in  a  carriage  may 
bring  on  permanent  constipation,  and  a  habit  of  involuntary  dis- 
charges, very  difficult  to  break  off.  The  diminution  of  the  erections 
under  these  circumstances  is  not  always  attributable  to  the  genital 
organs  becoming  accustomed  to  the  heat  and  motion  of  the  carriage; 
but  very  often  to  the  frequent  repetition  of  unnoticed  diurnal  pollu- 
tions. The  same  thing  may  happen  with  respect  to  daily  and  long- 
continued  horse  exercise.  Generally  the  organs  habituate  themselves 
to  the  action,  but  occasionally  diurnal  pollutions  come  on,  and  do 
not  readily  pass  off,  although  their  cause  may  have  been  removed. 

The  same  may  be  said  of  the  effects  of  long-continued  sitting,  in 
literary  men  and  others.  After  having  produced  increased  heat  in 
the  margin  of  the  anus  and  perineum,  with  frequent  and  prolonged 
erections,  sedentary  habits  are  often  followed  by  a  completely  oppo- 
site condition,  without  the  transition  from  one  state  to  another  being 
appreciable.    The  long  use  of  astringents  and  bitters,  together  with, 


LOCAL    SYMPTOMS.  255 

in  fact,  all  causes  capable  of  inducing  constipation,  tend  equally  to 
transform  diurnal  pollutions,  which  were  harmless  at  first,  into  serious 
and  intractable  disease. 

In  all  cases  of  this  nature,  it  is  not  habit  alone  that  tends  to  per- 
petuate the  evacuations ;  there  is  also  want  of  power  in  the  rectum, 
which  continues  to  increase  in  proportion  as  the  system  becomes 
weaker.  Defecation  requires  the  assistance  of  powerful  efforts  of  the 
abdominal  muscles,  and  this  produces  compression  of  the  seminal 
vesicles. 

On  the  other  hand,  all  causes  irritating  the  rectum  may  produce 
spasmodic  contractions  in  the  seminal  vesicles,  so  that  diurnal  pol- 
lutions may  be  produced  as  well  during  diarrhoea  as  during  consti- 
pation :  such  an  effect  is  generally  of  short  duration  ;  but  it  may  be- 
come permanent  provided  the  rectal  irritation  be  long  continued,  or 
return  frequently.  Such  susceptibility  of  the  seminal  vesicles,  too, 
announces  an  unfortunate  disposition  to  the  occurrence  of  these  dis- 
charges ;  and  this  is  the  point  of  chief  importance  in  the  considera- 
tion of  pollutions  produced  by  a  hot,  cold,  or  irritating  injection,  by 
an  active  purge,  &c. 

The  same  remarks  hold  good  when  applied  to  the  pollutions  ex- 
cited by  hsemorrhoids  ;  very  often  they  only  come  on  when  such 
heemorrhoids  are  increased  accidentally,  but  they  may  continue  after- 
wards, a'hd  even  become  habitual. 

In  all  such  cases  as  I  have  just  been  considering,  it  is  for  the  prac- 
titioner to  appreciate  the  importance  to  be  attached  to  the  discharges, 
and  it  is  by  their  effects  that  he  must  judge  them,  rather  than  by 
abundance  ;  for  some  patients  support  their  effects  better  than  others, 
and  the  danger  varies  according  as  they  are  accompanied  or  not  with 
other  pollutions — as,  for  instance,  with  those  that  occur  during  the 
discharge  of  urine. 

The  seminal  vesicles  sometimes  contract  from  sympathy,  rather 
than  from  being  compressed  by  the  rectum.  This  is  easily  observed, 
in  some  patients,  who  never  pass  semen  during  the  efforts  at  defeca- 
tion, but  only  after  the  passage  of  feces,  and  even  sometimes  whilst 
adjusting  their  dress.  In  such  cases  a  sudden  convulsive  shock  is 
felt  betAveen  the  perineum  and  neck  of  the  bladder,  sometimes  with 
slight  turgescence  of  the  penis  and  a  certain  amount  of  pleasure;  and 
the  fluid  is  discharged  by  two  or  three  spasmodic  contractions  which 
may  even  project  it  a  short  distance.  If  these  discharges  always 
occurred  after  defecation  they  would  be  as  easily  discovered  as  noc- 
turnal pollutions,  for  the  fluid  could  not  escape  the  patient's  observa- 
tion. But  such  cases  are  the  rarest;  and  in  all  others  the  discharges 
are  generally  the  less  suspected  in  proportion  as  the  disease  becomes 
more  serious.  In  fact,  at  first,  when  the  discharges  depend  on  long 
continence,  accidental  constipation,  &c.,  they  are  very  copious,  and 
generally  attended  with  more  or  less  turgescence  of  the  penis  and 
slight  sensations,  which  attract  attention.  The  semen,  too,  possess- 
ing its  normal  characteristics,  cannot  be  mistaken  in  these  cases,  and 


256  SYMPTOMS    OF    SPERMATOREH(EA. 

the  sensation  it  produces  in  passing  through  the  urethra  is  very  dif- 
ferent from  that  excited  by  the  passage  of  urine.  But  as  I  have 
before  stated,  in  proportion  as  the  disease  progresses,  the  semen 
becomes  more  aqueous ;  it  is  expelled  with  less  effort  and  less 
copiously.  Thus,  supposing  that  the  small  quantity  of  fluid  dis- 
charged be  not  passed  together  with  the  urine,  the  patient  may 
imagine  that  he  has  only  passed  mucus  or  prostatic  fluid — an  opinion 
which,  if  he  mention  the  circumstance  to  his  medical  attendant,  is 
very  likely  to  be  confirmed. 

It  is  well  known  that  after  violent  efforts  at  defecation,  a  small 
quantity  of  viscid  matter  may  be  expressed  from  the  follicles  of  the 
prostate,  and  may  form,  with  the  mucus  of  the  canal,  a  drop  of 
thick  and  stringy  fluid  which  stops  at  the  orifice  of  the  glans  ;  but 
is  this  the  reason  why  every  one  who  states  that  he  has  passed  se- 
men while  at  stool,  should  have  his  assertion  contradicted  without 
examination?  This,  nevertheless,  happens  daily.  Patients  who 
take  the  precaution  of  emptying  the  bladder  before  going  to  stool, 
are  not  to  be  so  easily  deceived  ;  for  the  prostatic  fluid,  joined  with  the 
urethral  mucus,  never  furnishes  more  than  one  or  two  drops  of  thick 
thready  matter,  which  is  almost  always  transparent ;  and  the  most 
simple  reasoning  suffices  to  show  that  these  fluids  never  can  be  expelled 
in  any  quantity  at  one  time,  because  they  have  no  reservoirs  to  ac- 
cumulate in.  Whenever,  therefore,  a  quantity  of  fluid  amounting  to 
a  spoonful  is  expelled  at  once,  there  can  be  no  chance  of  its  con- 
sisting merely  of  prostatic  fluid  and  mucus. 

Seminal  discharges  that  take  place  during  the  emission  of  urine 
are  the  most  serious  and  most  obstinate  of  all,  because  they  are  the 
most  often  and  most  easily  repeated.  They  are  also  very  obscure 
on  account  of  the  alterations  the  semen  undergoes,  and  of  its  mix- 
ture with  the  urine — at  least,  in  the  majority  of  cases.  I  must  there- 
fore lay  considerable  stress  on  the  means  by  which  the  presence  of 
these  discharges  may  be  ascertained. 

First,  the  semen  never  mixes  with  the  urine  at  the  commencement 
of  the  discharge.  It  only  escapes  with  the  last  drop,  and  when  the 
bladder  finishes  emptying  itself  by  energetic  and  spasmodic  contrac- 
tions ;  sometimes  even  it  escapes  by  itself  after  the  bladder  has  been 
completely  emptied.  The  desire  of  making  water  occurs  very  often 
in  these  cases,  and  sometimes,  though  comparatively  seldom,  the 
penis  becomes  slightly  turgescent,  and  two  or  three  convulsive  mo- 
tions expel  the  fluid  in  jets.  Generally,  however,  there  is  no  in- 
terval between  the  discharge  of  urine  and  the  seminal  flow,  and  the 
phenomena  are  so  connected  that  they  cannot  be  separately  distin- 
guished. I  have  verified  the  fact  of  the  semen  being  only  expelled 
during  the  last  contractions  of  the  bladder,  so  often,  however,  that 
there  can  be  no  doubt  on  the  point. 

Habitual  gleet  is  liable  to  become  aggravated  from  very  slight 
causes,  and  may  give  rise  to  a  cloud  in  the  urine,  which  it  is  possible 
may  be  taken  for  seminal  fluid ;  to  avoid  this  error,  it  is  sufficient  to 


LOCAL    SYMPTOMS.  257 

recollect  that  in  gleet  it  is  always  the  first  jet  of  urine  that  is  cloudy 
— the  cloud  consisting  of  cast  off  epithelial  scales,  mucus,  and  pros- 
tatic fluid,  which  have  accumulated  since  the  previous  act  of  mictu- 
rition. Whenever  the  bladder,  too,  contains  blood,  pus,  mucus,  &c., 
these  extraneous  matters,  being  heavier  than  the  urine,  are  collected 
near  the  neck  of  the  bladder,  and  consequently  are  discharged  first 
when  the  patient  is  standing.  The  contrary  takes  place  with  regard 
to  semen.  These  remarks  will  be  found  of  considerable  importance 
in  practice,  for  gleet  and  vesical  catarrh  are  often  present  at  the 
same  time  with  diurnal  pollutions,  and  render  the  diagnosis  very  ob- 
scure. In  simple  and  early  cases,  on  desiring  the  patient  to  make 
water  in  a  bath,  it  is  very  easy  to  distinguish  the  semen  discharged 
with  the  last  drops.  In  such  cases  it  possesses  considerable  opacity, 
andcontains  a  number  of  granules  which  become  dispersed  in  the  water, 
troubling  it  very  considerably.  In  older  cases  it  is  still  easy  by  a  little 
attention  to  prove  the  presence  of  semen: — the  urine  suddenly  ac- 
quires greater  density  ;  besides,  the  semen  is  seldom  so  totally  changed 
as  no  longer  to  contain  whitish  particles,  or  distinct  granules. 

It  must  be  borne  in  mind,  however,  that  the  variations  are  very 
great  between  one  day  and  another,  so  that  pollutions  may  not  be 
noticed  on  every  occasion. 

In  most  cases  the  presence  of  semen  in  the  urine  maybe  discovered 
at  the  first  view.  In  cases  that  are  recent,  small  semitransparent 
irregularly  spherical  granules  of  variable  size,  somewhat  resembling 
bran,  are  seen  at  the  bottom  of  the  vessel.  These  cannot  be  con- 
founded with  any  urinary  salt,  because  they  appear  before  the  fluid 
has  cooled  ;  they  are  soft,  and  do  not  adhere  to  the  sides  of  the  vessel. 
On  the  other  hand,  neither  urethra,  prostate,  bladder,  nor  kidneys 
can  furnish  similar  granules,  especially  when  the  urine  is  transparent; 
they  must  come,  therefore,  from  the  seminal  vesicles,  and  may  be 
regarded  as  a  sure  proof  of  diurnal  pollutions.  The  patients,  too, 
are  generally  made  aware  of  the  passage  of  the  semen  by  a  peculiar 
sensation,  arising  from  the  unaccustomed  density  of  the  urine;  they 
often  distinguish  also  the  spasmodic  contractions  of  the  seminal  ve- 
sicles which  produce  these  diurnal  pollutions.  It  is  worthy  of  re- 
mark too  that  such  pollutions  occur  almost  always  after  some  vene- 
real excitement,  as,  for  example,  after  an  erotic  dream,  lascivious 
conversation,  &c.  ;  or,  after  some  mechanical  excitement  of  the  ge- 
nital organs ;  and  often  while  the  erectile  tissues  are  more  or  less 
turgescent,  the  desire  of  micturition  is  felt.  The  union  of  these  cir- 
cumstances sufficiently  indicates  that  such  pollutions  are  the  least 
passive  of  those  that  occur  during  the  passage  of  urine  ;  they  are 
also  the  least  serious  and  the  most  rare. 

Other  patients  experience  very  difi'erent  phenomena.  The  penis 
shrinks  towards  the  pubes  in  consequence  of  the  pain  that  extends 
from  the  neck  of  the  bladder  to  the  glans.  The  passage  of  the  urine 
over  a  very  irritable  point  of  the  canal  causes  the  spasmodic  con- 
tractions into  which  the  sphincters  and  seminal  vesicles  soon  enter. 


258  SYMPTOMS    OF    SPERMATORRHEA. 

DiiFerent  sensations  sometimes  announce  the  occurrence  of  a  pollu- 
tion ;  sometimes  it  is  a  sense  of  heat  at  the  margin  of  the  anus  ; 
sometimes  a  shiver  or  general  uneasiness;  and,  occasionally,  a  dart- 
ing pain  in  the  nipple,  &c.  Patients  who  are  accustomed  to  these 
particular  occurrences  well  know  that  they  will  find  a  deposit  of 
flocculent  matter  in  their  urine  after  experiencing  them. 

When  the  disease  has  made  further  progress  the  passage  of  the 
semen  is  hardly  appreciable  by  the  patients,  and  the  urine  no  longer 
deposits  such  large  granules  at  the  bottom  of  the  vessel.  There  is, 
however,  a  thick  homogeneous  whitish  cloud  sprinkled  with  little 
brilliant  points  which  descend  to  the  bottom  of  the  vessel,  and  have 
been  compared,  with  justice,  to  the  deposit  formed  in  a  strong  de- 
coction of  barley  or  rice.  Repeated  microscopic  examinations  have 
left  no  doubt  on  my  mind  that  such  clouds  are  in  a  great  measure 
due  to  much  altered  semen,  and  that  the  brilliant  points  come  from 
the  seminal  vesicles. 

Certain  precautions  are  necessary  in  order  to  observe  all  the  cha- 
racteristics of  which  I  have  spoken.  In  the  first  place  each  dis- 
charge of  urine  should  be  collected  in  a  separate  vessel,  because  the 
excretions  passed  at  different  parts  of  the  day  do  not  often  present 
the  same  appearances.  The  morning  urine  generally  contains  most 
deposit,  especially  when  the  night  has  been  restless.  Urine  passed 
after  moral  or  physical  excitement  of  the  genital  organs  also  con- 
tains a  large  quantity,  as  well  as  that  after  a  sudden  chill,  an  attack 
of  indigestion  or  violent  emotion  of  any  kind.  Often  the  urine  is 
perfectly  transparent  during  a  whole  day,  or  several  days,  and  the 
patients  under  these  circumstances  experience  a  remarkable  im- 
provement in  their  symptoms. 

This  method  of  studying  the  urine  permits  us  therefore  to  follow 
all  the  oscillations  of  the  disease,  and  to  appreciate  those  causes 
which  act  most  energetically  on  each  individual.  Such  causes  may 
be  very  different,  and  even  opposite  to  one  another ;  thus,  for  in- 
stance, in  one  person,  cold  dry  weather  is  injurious  ;  in  another, 
warm  and  moist. 

The  vessels  to  receive  the  urine  ought  to  be  quite  transparent. 
Round  bottomed  glasses  like  exaggerated  and  much  deepened  watch 
glasses  are  useful ;  but  champagne  glasses  are  more  advantageous 
when  the  deposit  is  wanted  for  microscopic  research. 

Other  Diurnal  Pollutions. — Certain  other  diurnal  pollutions  may 
occur,  but  in  such  cases  there  are  generally  involuntary  discharges 
during  defecation  and  the  emission  of  urine,  present  at  the  same 
time. 

Such  pollutions  may  take  place  during  horse  exercise,  from  the 
jolting  of  a  carriage,  the  friction  of  the  clothing,  mental  excitement, 
and  in  a  few  very  rare  cases  without  either  moral  or  physical  provo- 
cation. In  the  last  cases  the  patients  experienced  suddenly,  while 
engaged  in  study,  a  pinching  in  the  prostatic  region,  with  a  sense  of 
spasmodic  contraction  between  the  bladder  and  rectum;  perhaps  they 


I 


LOCAL    SYMPTOMS.  259 

get  rid  of  these  sensations  by  chano;e  of  posture,  pinching  the  skin, 
&c. ;  but  the  discharge  of  semen  takes  place  with  the  next  emission 
of  urine.  I  can  only  attribute  these  phenomena  to  some  special  irri- 
tation of  the  seminal  vesicles,  or  of  the  nerves  distributed  to  them. 

Impotence. — Loss  of  virility,  when  not  attributable  to  any  evident 
cause,  must  be  considered  a  local  symptom,  and  one  of  the  most 
certain  of  involuntary  seminal  discharges.  The  effects  of  age,  of 
serious  diseases,  and  of  lesions  of  the  testicles  are  of  course  left  out 
of  the  question  in  this  statement :  and  there  are  also  other  cases  which 
must  be  carefully  distinguished  from  habitual  and  acquired  impotence. 

Under  the  influence  of  powerful  moral  impressions,  of  whatever 
kind,  the  genital  organs  may  occasionally  not  respond  to  the  most 
energetic  desires.  Sometimes  even  the  violence  of  the  excitement 
may  prevent  its  external  manifestation.  But  this  condition  passes 
off  with  its  exciting  causes,  and  the  same  individual  under  other 
circumstances  regains  his  normal  vigor.  Such  accidental  occur- 
rences must,  therefore,  be  distinguished  from  habitual  impotence. 

In  other  cases,  too,  the  evolution  of  the  genital  instinct  never  per- 
fectly takes  place  ;  some  even  never  experience  a  commencing  pu- 
berty. I  once  saw  a  man,  thirty  years  of  age,  very  fat,  without  beard 
or  hair  on  the  pubes,  whose  testicles  and  penis  appeared  to  belong 
to  a  child  of  seven  or  eight  years ;  he  had  never  experienced  either 
erections  or  venereal  desires.  This  case  may  be  considered  as  the 
type  of  congenital  impotence.  It  is  rarely  so  complete,  but  in  no 
case  must  it  be  confounded  with  the  acquired  condition. 

On  the  other  hand,  again,  acquired  impotence  presents  different  de- 
grees which  are  important.  Some  patients  never  have  complete  erec- 
tions, others  only  experience  them  accidentally,  as,  for  instance,  at 
the  moment  of  waking,  or  when  the  rectum  or  bladder  is  distended. 
But  such  erections  never  acquire  the  same  degree  of  energy  as 
normal  ones.  In  other  persons  again  the  morbid  sensibility  of  the 
organs  is  so  great  that  emission  takes  place  on  the  least  contact,  with- 
out perfect  rigidity  of  the  corpora  cavernosa.  In  this  case — the  least 
serious  and  the  most  common  of  all — there  is  yet  impotence,  even 
although  intromission  be  possible,  because  fecundation  cannot  be  the 
result  of  so  precipitate  an  act,  by  means  of  which  the  seminal  fluid 
cannot  pass  into  the  neck  of  the  uterus.  These  are  cases  of  only 
commencing  impotence,  which  may  be  as  slight  as  possible ;  but 
when  it  has  continued  some  little  time,  Ave  may  be  sure  that  involuntary 
discharges  are  present.  Those  involuntary  discharges  which  take 
place  during  defecation  and  the  emission  of  urine  being  the  only 
ones  of  which  the  patient  may  not  be  aware,  we  may  infer  whenever 
any  notable  and  permanent  diminution  of  the  genital  functions  oc- 
curs, that  the  patient  suffers  from  diurnal  pollutions.    • 

The  presence  of  well-formed  semen  in  the  seminal  vesicles  is  the 
cause  of  all  normal  erections,  and  without  this  essential  condition 
either  direct  or  indirect  excitement  would  have  no  action  on  the 
erectile  tissues  ;  habitual  and  acquired  impotence,  therefore,  arises 


260  SYMPTOMS    OF    SPERMATOEEH(EA. 

from  the  want  of  the  normal  stimulus  in  the  vesicles,  and  is,  conse- 
quently, one  of  the  most  certain  signs  of  the  presence  of  diurnal 
pollutions. 

I  now  proceed  to  consider  the  means  by  which  the  actual  presence 
of  semen  in  the  urine,  or  under  other  circumstances,  can  be  unequi- 
vocally demonstrated. 

Chemical  Analysis. — The  analysis  of  animal  matters  is  too  com- 
plicated a  process  and  too  uncertain  in  its  results  to  permit  of  its 
employment  by  practical  men  in  distinguishing  semen  from  mucus 
or  prostatic  fluid.  The  use  of  warm  water  applied  to  stains  on  the 
linen  in  order  to  favor  the  evaporation  of  the  odoriferous  particles 
cannot  strictly  be  considered  a  chemical  process,  and  the  odor  of 
semen  passes  off"  too  rapidly  to  allow  of  its  being  always  ascertained 
by  our  obtuse  olfactory  organs.  It  is,  therefore,  a  distinctive  cha- 
racter of  little  importance,  whatever  acuteness  the  sense  of  smell 
may  acquire  from  long  habit. 

Microscopic  Examination. — Since  the  discovery  of  the  spermatozoa 
their  presence  in  the  seminal  fluid  has  attracted  the  attention  of  all 
who  have  sought  means  of  distinguishing  it  from  other  fluids.  Micro- 
scopic examination  of  the  spermatozoa,  however,  not  only  requires  an 
excellent  instrument,  but  certain  precautions  which  may  be  dispensed 
with  in  the  investigation  of  coarser  objects.  As  the  spermatic  ani- 
malcules can  be  only  seen  by  means  of  transmitted  light,  it  is  neces- 
sary that  the  glass  on  which  the  fluid  to  be  examined  is  placed  should 
be  of  uniform  thickness,  and  without  bubbles  or  strips.  The  fluid  to 
be  examined  should  be  covered  by  another  layer  of  extremely  thin 
glass  made  on  purpose,  and  not  by  portions  of  mica,  which  are  seldom 
free  from  cracks,  and  never  perfectly  transparent.  This  thin  layer  of 
glass  is  indispensable  in  order  as  much  as  possible  to  diminish  the 
thickness  of  the  fluid,  to  render  it  perfectly  uniform,  to  hinder  eva- 
poration and  prevent  the  object  glass  from  being  soiled  by  it.  A 
single  drop  of  fluid  suffices  for  a  complete  observation,  a  larger  quan- 
tity always  proving  inconvenient.  The  little  glass  that  covers  the 
liquid  must  be  firmly  pressed  down  so  as  to  spread  it  out,  arrest  the 
currents  that  take  place  in  it,  and  drive  out  the  air  bubbles.  Although 
the  glasses  should  seem  to  touch  each  other,  the  spermatozoa  move 
with  perfect  freedom  in  the  space  between  them,  so  long  as  they 
preserve  their  energy  and  evaporation  has  not  proceeded  too  far ; 
should  such  be  the  case,  however,  a  drop  of  tepid  water  favors  and 
much  prolongs  their  motions.  However  thin  the  layer  of  fluid  may 
be,  it  is  impossible  to  comprehend  its  whole  thickness  at  once  with  a 
very  high  power,  and  it  is,  therefore,  necessary  to  alter  the  focus 
frequently  in  order  to  be  sure  that  nothing  escapes  observation.  And 
this  is  especially  important  in  examining  a  drop  of  fluid  obtained  from 
diurnal  pollutions,  because  there  are  frequently  only  two  or  three 
spermatozoa  contained  in  it.  It  is  also  necessary  to  change  the  posi- 
tion of  the  reflector  frequently  in  order  to  vary  the  direction  and 
intensity  of  the  light.     The  spermatozoa  are  often  exceedingly  trans- 


LOCAL    SYMPTOMS.  261 

parent  in  cases  of  disease,  and  a  very  bright  perpendicular  light  is 
by  no  means  the  best  for  showing  them.  Varying  the  density  of 
the  fluid  under  examination,  either  by  adding  water  or  by  permittino- 
evaporation,  is  also  often  useful.  The  semen  contains  matters  fur- 
nished by  the  seminal  vesicles,  the  prostate  and  the  urethra,  and 
when  the  fluid  is  too  thick  these  matters  hide  the  animalcules.  A 
drop  of  water  applied  to  the  edge  of  the  covering-glass  penetrates 
underneath  it,  and  the  spermatozoa  are  more  isolated,  at  the  sam.e 
time  that  their  contour  is  rendered  more  defined  by  the  diminution  in 
density  of  the  fluid.  On  the  other  hand  the  refractive  power  of  the 
spermatozoa  difl"ers  little  from  that  of  the  fluid  in  which  they  are  con- 
tained, and  their  thinnest  portions  are  traversed  by  the  light  without 
aff'ording  any  distinct  images  to  the  eye.  In  this  case  there  are  only 
seen  very  small  ovoid  brilliant  globules  terminated  by  a  little  point. 
As  soon  as  the  water  begins  to  penetrate  between  the  glasses,  the 
rapid  motion  set  up  prevents  the  objects  from  being  clearly  distin- 
guished ;  but  as  soon  as  rest  has  been  re-established  the  tails  of  the 
animalcufes  appear,  and  their  dimensions  seem  to  have  increased  in 
consequence  of  the  diminished  density  of  the  surrounding  fluid;  water 
suffices  to  produce  this  result.  It  is  more  sensible,  however,  when  a 
small  quantity  of  alcohol  is  added  :  but  the  forms  of  the  animalcules 
are,  after  a  time,  altered  by  this  agent;  and  it  is,  therefore,  advisable 
to  use  water  only  when  it  is  intended  to  keep  the  preparation. 

Evaporation  sometimes  produces  not  less  remarkable  changes  in 
the  seminal  fluid.  I  have  frequently  in  cases  of  spermatorrhoea  failed 
to  perceive  anything  in  the  fluid  under  examination  for  half  an  hour, 
an  hour,  or  more  ;  then  suddenly  an  animalcule  has  made  its  appear- 
ance ;  then  a  dozen,  and  then  perhaps  a  hundred  in  the  space  of  a 
few  minutes.  The  following  morning,  when  desiccation  has  become 
complete,  there  are  no  longer  any  traces  of  these  animalcules,  or,  at 
all  events,  I  have  been  only  able  to  distinguish  their  tails,  the  other 
parts  of  them  being  fixed  in  the  dried-up  mucus.  The  absorption 
of  a  drop  of  water  has  restored  the  phenomena  observed  the  night 
before. 

These  phenomena  are  easily  explained:  when  the  refractive  power 
of  the  spermatozoa  is  the  same  as  that  of  the  circumambient  liquid, 
the  light  traverses  the  whole  in  the  same  manner,  and  the  mass  ap- 
pears homogeneous.  But  evaporation  acts  more  rapidly  on  the  liquid 
than  on  the  organized  bodies  contained  in  it ;  and  when  the  diff"erence 
of  density  alters  the  refractive  power  the  forms  of  the  spermatozoa 
are  momentarily  defined  because  they  have  become  more  transparent 
than  the  remainder  of  the  fluid.  When  desiccation  is  complete, 
however,  the  animalcules  again  disappear,  because  the  refractive 
powers  of  mucus  and  dried  animalcules  are  again  equal.  The  ab- 
sorption of  a  small  quantity  of  water  reproduces  the  same  pheno- 
mena, which  may  be  repeated  almost  indefinitely,  since  the  matter 
confined  between  the  two  layers  of  glass  undergoes  no  other  appre- 
ciable alteration. 
17 


262  SYMPTOMS    OF    SPERMATOREHCEA. 

In  order  to  be  enabled  to  discover  spermatozoa  quickly  in  cases 
of  disease,  it  is  necessary  that  they  should  be  well  studied  in  healthy 
cases.  This  may  be  accomplished  in  the  following  manner :  After 
coitus  there  always  remains  a  sufficient  quantity  of  seminal  fluid  in 
the  urethra  to  serve  for  precise  and  complete  microscopical  exami- 
nation. This  may  be  obtained  by  pressing  the  canal  shortly  after 
the  act,  and  receiving  the  drop  of  fluid  from  the  orifice  of  the  glans 
on  a  plate  of  glass.  In  this  drop  of  fluid  thousands  of  animalcules 
may  be  seen,  agitating  themselves  like  so  many  tadpoles  in  a  pool  of 
stagnant  water,  only  that  the  tails  of  the  spermatozoa  are  relatively 
longer  and  thinner,  and  that  the  head  presents  a  brilliant  point  near 
its  insertion.  Generally  the  number  of  these  animalcules  prevents 
them  from  being  easily  examined,  and  it  becomes  necessary  to  spread 
them  out  by  introducing  a  small  quantity  of  water,  and  pressing 
firmly  down  the  thin  glass  that  covers  them  ;  they  are  found  most 
separated  on  the  edges  of  the  fluid.  If  the  water  added  be  of  the 
temperature  of  the  body  their  motions  become  free  and  lively,  and 
continue  so  until  cooling  and  evaporation  aff'ect  them.  By  avoiding 
these  two  causes  of  disturbance  the  motions  of  the  spermatozoa  may 
be  kept  up  during  several  hours. 

However  long  a  time  may  have  elapsed  after  coitus  there  are  al- 
ways spermatozoa  in  the  urethra,  provided  they  have  not  been  washed 
away  by  the  passage  of  urine.  Although  the  point  of  the  glans  may 
be  quite  dry,  and  pressure  along  the  whole  length  of  the  canal 
may  not  produce  the  least  dampness,  still  on  passing  urine  living 
animalcules  may  be  obtained  from  the  first  drop  which  escapes. 
This  may  be  received  on  the  glass,  and  is  perhaps  the  earliest  and 
most  natural  mode  of  obtaining  spermatozoa  from  microscopic  exa- 
mination. 

It  is  evident  that  the  same  experiments  may  be  applied  in  the  case 
of  nocturnal  pollutions  as  well  as  in  all  other  seminal  discharges  in 
whatever  manner  they  may  occur.  But  many  errors  may  arise  from 
commencing  with  cases  of  disease,  for  it  is  during  perfect  health  that 
the  spermatozoa  are  most  active,  and  their  development  most  com- 
plete, and  they  live  longer  after  coitus  than  after  any  other  kind  of 
seminal  discharge. 

Having  thus  described  the  means  by  which  my  microscopic  obser- 
vations may  be  verified,  I  proceed  to  show  their  results. 

Spermatozoa. — Out  of  thirty-three  bodies  which  I  have  examined 
for  spermatozoa,  I  only  twice  found  these  animalcules  in  the  testicles. 
In  one  of  these  cases  the  patient  died  from  the  eflfects  of  a  fall  on  the 
day  following  it ;  in  the  other  acute  gastro-enteritis  was  the  cause  of 
death.  The  seminal  fluid  was  most  abundant,  and  contained  the 
greatest  number  of  animalcules  in  the  former  case.  The  other  pa- 
tients died  of  chronic  diseases  after  protracted  sufferings.  One  only 
among  them  died  on  the  second  day  of  acute  peritonitis,  but  he  was 
seventy-three  years  of  age.  In  thirty- one  of  these  patients  the  tes- 
ticles were  soft,  pale,  and  as  though  withered.     On  section  they  pre- 


LOCAL    SYMPTOMS.  "  263 

sented  a  grayish  aspect,  and  did  not  furnish  any  liquid  ;  the  structure 
was  almost  dry,  and  contained  few  blood  vessels  ;  the  secretins^ 
canals  were  easily  separated  from  one  another,  and  could  be  spread 
out  under  the  microscope  without  breaking.  They  presented  very 
brilliant  granules,  all  of  exactly  the  same  appearance,  about  the  size 
of  the  head  of  a  spermatozoon,  ten  times  smaller  than  corpuscles  of 
blood  or  mucus,  and  differing  from  the  latter  by  the  constancy  and 
regularity  of  their  form.  These  brilliant  bodies  which  occupied  the 
place  of  the  spermatozoa,  arc  worthy  of  notice,  because  they  offer 
considerable  analogy  to  the  appearances  presented  by  the  semen 
under  certain  circumstances. 

In  order  to  observe  what  is  present  in  the  secreting  canals  of  the 
testicle  it  is  necessary  to  spread  out  a  portion  of  one  of  them  under 
the  microscope,  after  having  examined  it  dry  to  allow  a  drop  of 
water  to  penetrate  between  the  two  glasses,  and  to  follow  the  changes 
which  take  place;  then  to  press  down  the  glass  so  as  to  flatten  the 
parietes  of  the  canal,  rupture  it,  and  press  out  a  portion  of  its  con- 
tents ;  lastly,  these  must  be  examined  again  when  desiccation  is 
complete,  for  the  spermatozoa  found  in  the  canals  are  then  best  seen. 

In  the  epididymis  I  have  never  found  spermatozoa,  except  in  the 
two  cases  in  which  they  were  also  found  in  the  testicles.  In  all  the 
others  I  met  with  these  animalcules  only  in  the  vasa  deferentia  or 
seminal  vesicles.  There  were  no  animalcules  at  all  to  be  found  in 
the  patient  who  died  at  the  age  of  seventy-three.  It  has  always 
seemed  to  me  that  the  animalcules  were  less  numerous  in  proportion 
as  the  patients  had  suffered  long ;  and  in  extreme  cases  I  have  gene- 
rally found  them  only  in  the  seminal  vesicles.  The  fewer  the  sper- 
matozoa the  more  difficult  were  they  of  detection  on  account  of  their 
extreme  transparency.  In  some  cases  I  have  only  suddenly  dis- 
covered them  after  examining  for  an  hour  or  two,  the  liquid  having 
previously  appeared  quite  homogeneous.  The  dimensions  were  the 
same  as  those  of  the  best  developed  animalcules,  but  they  were  pale 
throughout  their  whole  extent,  and  more  transparent  than  the  sur- 
rounding fluid.  Complete  desiccation  often  caused  them  to  disap- 
pear altogether;  but  the  same  phenomena  could  be  reproduced  by 
the  absorption  of  a  small  quantity  of  water. 

In  cases  of  phthisis,  caries  of  the  vertebrae,  white  swelling,  &c.,  I 
have  had  great  difficulty  in  distinguishing  the  animalcules,  probably 
because  these  diseases  do  not  cause  death  for  a  long  time. 

I  have  almost  always  found  in  the  seminal  Vesicles,  especially  at 
the  bottom  of  any  depressions,  a  thick,  grumous,  brilliant  matter, 
varying  in  its  aspect  and  color,  but  considerably  resembling  thick 
paste,  and  more  or  less  transparent ;  with  a  high  power  the  granules 
of  this  matter  appear  large,  iiTegular,  more  or  less  opaque,  and  with- 
out any  constant  shape.  They  are  evidently  the  products  of  the 
internal  membrane  of  the  vesicles,  for  they  are  found  with  similar 
characters  in  the  accessory  vesicles  of  the  hedgehog,  rat,  &c.,  which 
never  contain  seminal  animalcules,  and  do  not  communicate  directly 


264  SYMPTOMS    OF    SPERMATOEEHOEA. 

with  the  vasa  deferentia,  which,  again,  never  contain  any  similar 
substance.  This  matter  is,  therefore,  analogous  to  that  secreted 
by  the  prostatic  follicles,  Cowper's  glands,  &c.  Its  functions  are 
the  same,  and  for  many  reasons  it  merits  special  attention. 

The  secretion  of  semen  diminishes  in  all  serious  diseases,  and 
seminal  evacuations  become  very  rare,  especially  towards  the  last. 
It  is  not,  therefore,  astonishing  that  the  products  of  the  mucous  mem- 
brane predominate  in  such  patients  over  those  of  the  testicles,  and 
that  such  mucus  should  become  more  consistent  during  its  long 
residence  in  the  depressions  of  the  vesicles.  Hence  the  difference 
observable  between  the  semen  obtained  from  the  vesicles  after  death, 
and  that  which  is  passed  by  a  healthy  person.  Nevertheless,  after 
long-continued  continence  more  or  less  large  granules  are  often  seen 
in  the  semen  of  a  healthy  person,  and  these  are  perfectly  distinct 
from  the  fluid  part.  When  the  emissions  are  more  frequent,  gra- 
nules of  the  same  kind  may  be  observed,  but  much  smaller.  These, 
facts  are  important  when  applied  to  explain  several  symptoms  of 
diurnal  pollutions. 

I  have  already  stated  that  on  causing  the  patients  to  make  water 
in  a  bath,  the  semen  passed  may  be  easily  recognized  by  means  of 
its  globules  which  whirl  about  in  the  middle  of  the  cloud  formed  to- 
wards the  close  of  micturition.  From  what  we  have  just  seen  it  is 
evident  that  these  globules  come  from  the  internal  membrane  of  the 
seminal  vesicles.  They  may  be  wanting  in  very  severe  cases  where 
the  semen  has  no  time  to  acquire  consistence ;  but  their  presence 
leaves  no  doubt  as  to  the  existence  of  diurnal  pollutions,  because 
they  can  only  be  furnished  by  the  seminal  vesicles.  On  the  other 
hand,  I  have  invariably  found  spermatozoa  in  the  urine  of  patients 
who  observed  this  phenomenon  in  the  bath.  The  same  remarks  hold 
good  when  applied  to  the  globules  which  the  urine  deposits  in  cer- 
tain cases  of  diurnal  pollutions,  and  which  have  been  compared  by 
some  to  grains  of  bran,  by  others  to  millet-seed,  pearl  barley,  &c., 
according  to  their  size.  These  globules  are  perceived  as  soon  as  the 
urine  is  passed  ;  they  are  roundish,  very  soft,  and  do  not  give  any 
sensation  when  squeezed  between  the  finger  and  thumb  ;  they  can- 
not, therefore,  be  confounded  with  urinary  salts  which  are  deposited 
only  when  the  urine  is  cooled,  have  a  crystalline  form,  and  give 
the  sensation  of  a  hard  body  to  the  finger.  The  vesical  mucus  also 
is  only  deposited  on  cooling,  and  does  not  furnish  brilliant  granules. 
As  to  pus,  its  appearance  is  easily  determined.  I  have  found  animal- 
cules whenever  these  globules  appeared  in  the  urine ;  and  hence  it  is 
that  I  have  pointed  them  out  as  certain  signs  of  diurnal  pollutions. 

I  have  also  noticed  that  in  some  cases  the  urine,  when  held  against 
the  light,  presents  in  the  middle  of  a  flocculent  cloud  multitudes  of 
quite  characteristic  brilliant  points.  These  are  smaller,  and  conse- 
quently lighter  globules  than  those  which  in  other  patients  fall  to  the 
bottom  of  the  vessel.  They  are  neither  observed  in  the  mucus  of  the 
bladder  nor  in  the  prostatic  fluid,  which  alone  present  clouds  analo- 


LOCAL    SYMPTOMS.  265 

gous  to  those  of  diurnal  pollutions.  Such  brilliant  points  also  arise 
from  the  seminal  vesicles,  and  their  presence  is,  therefore,  an  indi- 
cation that  the  urine  contains  semen.  This  I  have  often  verified  with 
the  microscope.  I  should,  however,  warn  those  who  wish  to  repeat 
my  experiments,  that  it  is  not  in  the  midst  of  the  flocculent  cloud 
that  the  zoosperms  are  to  be  sought,  but  at  the  bottom  of  the  vessel, 
to  which  they  soon  fall  on  account  of  their  greater  specific  gravity. 
The  results  of  all  my  observations  on  the  dead  subjects,  therefore, 
convince  me  of  the  influence  of  serious  and  long  continued  diseases 
on  the  functions  of  the  spermatic  organs.  But  it  is  not  only  in  the 
morbid  state  that  these  experience  great  variations ;  remarkable 
differences  may  exist  between  healthy  individuals  not  only  in  the 
quantity  of  semen  secreted  in  a  given  time,  but  also  in  the  number, 
appearance,  and  dimensions  of  the  spermatozoa.  In  this  respect  I 
have  observed  differences  amounting  to  a  third,  and,  in  some  cases, 
to  half.  The  comparison  is  very  easily  established.  When  the  semen 
is  kept  under  a  thin  glass,  as  I  have  before  described,  it  is  not  in 
danger  of  undergoing  any  changes,  and  may  be  always,  by  the  ad- 
dition of  a  drop  of  water,  compared  with  a  recent  specimen. 

Notwithstanding  the  facility  with  which  nocturnal  pollutions  may 
be  recognized,  I  have  submitted  the  semen  collected  after  them,  by 
individuals  in  various  conditions  of  health,  to  microscopic  examina- 
tion. At  first,  when  the  evacuations  are  still  rare,  and  the  semen 
preserves  its  ordinary  characteristics,  the  animalcules  do  not  present 
any  remarkable  circumstance  in  regard  to  their  number,  dimensions, 
&c.;  but  when  the  disease  has  reached  a  sufficient  degree  of  gravity 
to  affect  the  rest  of  the  system,  the  semen  becomes  more  liquid,  and 
the  spermatic  animalcules  less  developed  and  less  lively.  Their 
number,  however,  does  not  as  yet  sensibly  diminish  ;  indeed,  in  some 
cases  it  seems  increased.  As  the  disorder  advances,  the  erections 
diminish,  the  semen  becomes  more  watery,  and  the  animalcules  are 
often  a  fourth  or  a  third  less  than  natural,  and  the  tail  is  often  dis- 
tinguished with  difficulty  under  a  power  of  three  hundred  diameters. 
At  a  still  later  period  the  animalcules  become  fewer,  and  in  two 
individuals  in  the  last  stage  of  the  affection  the  semen  no  longer 
contained  animalcules,  although  it  retained  its  characteristic  smell. 
Examined  with  high  powers  and  every  proper  precaution,  I  only 
found  in  this  semen  brilliant  globules,  all  exactly  alike,  and  about 
the  same  size  as  the  head  of  a  spermatozoon. 

The  microscopic  examinations  which  I  have  made  of  semen  passed 
during  efforts  at  stool  give  analogous  results.  When  such  discharges 
only  take  place  accidentally  and  at  long  intervals,  the  semen  is  thick, 
whitish,  impregnated  with  a  powerful  smell,  and  abundantly  furnished 
with  well  developed  animalcules.  I  have  sometimes  even  found  a  few 
alive  after  an  hour  or  two.  But  when  these  discharges  become  so 
frequent  or  habitual  as  to  constitute  disease,  they  become  less  abun- 
dant and  the  semen  loses  its  normal  properties.     The  spermatozoa 


266  SYMPTOMS    OF    SPEEMATORRHCEA. 

are  generally  smaller  than  in  the  healthy  condition,  and  always 
less  lively.  I  have  some  preparations  in  which  they  are  only  of 
half  the  ordinary  size,  and  I  have  never  been  able  to  find  a  single 
lining  animalcule  a  few  minutes  after  the  fluid  had  been  expelled. 
When  the  disease  has  become  much  aggravated,  the  spermatozoa  be- 
come rare,  and  they  are  sometimes  replaced  by  ovoid  or  spherical 
globules  similar  to  those  of  which  I  have  already  spoken.  In  three 
patients  in  an  extreme  state  of  disease  I  found  nothing  else,  although 
they  passed  as  much  as  a  dessertspoonful  of  semen  at  each  stool. 
Such  cases,  however,  are  exceedingly  rare. 

In  diurnal  pollutions  happening  during  the  passage  of  urine  the 
following  means  may  be  employed  to  show  the  presence  of  sperma- 
tozoa. 

The  urine  should  first  be  filtered  in  a  conical  filter,  when,  on  ac- 
count of  their  weight,  the  greater  number  of  the  spermatozoa  will 
remain  on  the  lowest  part  of  the  paper.  By  taking  this  portion  and 
turning  it  upside  down  in  a  watch-glass  containing  a  few  drops  of 
water,  the  animalcules  become  detached  from  the  paper  by  degrees, 
and  fall  to  the  bottom  of  the  fluid  in  the  glass,  iifter  twenty-four 
hours'  maceration  in  this  position,  the  paper  may  be  taken  away  and 
the  spermatozoa  may  be  readily  obtained  by  using  a  drop  from  the 
bottom  of  the  fluid  in  the  watch-glass  for  examination.  This  mode 
of  proceeding  is  a  sure  one,  but  it  re(i[uires  considerable  time  and 
trouble  for  its  performance.  I  have  already  stated  that  the  urine 
does  not  always  contain  spermatozoa  in  cases  of  diurnal  pollutions  ; 
therefore,  the  urine  of  the  same  individual  would  perhaps  require 
examination  on  many  occasions  before  the  certainty  of  their  presence 
could  be  established,  and  few  medical  men  in  active  practice  have 
time  to  devote  to  such  experiments.  I  for  one  should  have  long 
since  given  up  treating  these  patients  had  I  been  obliged  to  repeat  in 
every  case  such  long  and  tiresome  examinations.  Ten  days  or  a  fort- 
night are  sometimes  passed  without  the  appearance  of  spermatozoa 
in  the  urine,  and  hence  all  who  are  accustomed  to  microscopic  re- 
searches will  admit  the  indefinite  amount  of  trouble  and  time  required. 

Fortunately,  however,  there  is  a  more  simple  method  by  which 
such  examinations  may  be  conducted.  It  will  be  recollected  that  the 
semen  always  escapes  either  with  the  last  drops  of  urine  or  imme- 
diately, or  soon  afterwards.  By  directing  the  patient,  therefore,  to 
compress  the  urethra  immediately  after  micturating,  and  to  receive 
the  drop  of  fluid  pressed  out  on  a  piece  of  glass,  sufficient  animalcules 
will  be  obtained  from  the  walls  of  the  urethra  for  microscopic  obser- 
vation. These  being  covered  with  a  thin  lamella  of  glass  may  be 
either  at  once  placed  under  the  microscope,  or  may  be  allowed  to 
dry,  and  examined  at  a  future  time,  a  drop  of  water  being  previously 
added.  This  mode  of  examination  is,  therefore,  easy  for  all  practi- 
tioners who  possess  a  good  microscope,  after  they  have  accustomed 
themselves  to  the  inspection  of  the  spermatozoa  in  their  natural  state. 


LOCAL    SYMPTOMS.  267 

The  changes  which  I  have  mentioned  as  occurring  in  the  semen  must 
be  borne  m  mind,  however,  and  the  animalcules  must  not  be  expected 
to  appear  either  so  large,  so  well  defined,  or  so  numerous  as  in  cases 
where  there  is  no  disease. 

Some  interesting  microscopic  researches  have  been  made  on  the 
stains  of  semen  appearing  on  linen,  but  as  these  are  too  complicated 
for  ordinary  cases,  and  are  chiefly  of  use  in  medico-legal  investiga- 
tions, I  need  not  give  any  account  of  them  here. 


I 


263  SYMPTOMS    OF    SPERMATOREHCEA. 


CHAPTER  XII. 


SYMPTOMS  OF  SPERMATORRHGE A. 


General  Symptoms. 

Infecundity . — Impotency  is  an  absolute  cause  of  infecundity,  be- 
cause it  prevents  the  conditions  necessary  to  fecundation  from  taking 
place  ;  but  although  the  act  of  coitus  may  be  accomplished,  it  does 
not  follow  that  the  person  should  always  be  able  to  perpetuate  his 
species.  Stricture  of  the  urethra  may  prove  an  obstacle  to  the  dis- 
charge of  seminal  fluid  ;  or  the  fluid  may  be  directed  towards  the 
bladder  on  the  parietes  of  the  urethra,  by  deviation  of  the  orifices  of 
the  ejaculatory  ducts.  The  secretion  may  be  altered  in  its  nature, 
it  may  only  contain  imperfect  spermatozoa,  &c.  A  man  may,  there- 
fore, be  unfruitful  without  being  impotent.  On  the  other  hand,  I 
have  met  with  many  patients  suff'ering  from  diurnal  pollutions  who 
had  children  exactly  resembling  them,  even  during  the  duration  of 
their  disease.  Indeed,  I  have  seen  several  cases  in  which  the  dispo- 
sition to  involuntary  discharges  was  hereditary,  and  they  afi'ected 
both  father  and  son.  The  disease  is,  however,  essentially  irregular 
in  its  progress  ;  it  may  continue  long  without  doing  serious  injury 
to  the  health ;  long  remissions  may  be  experienced,  or  even  a  perfect 
cessation  of  the  complaint  for  a  longer  or  shorter  time  ;  we  may  ea- 
sily conceive,  therefore,  that  in  the  first  degree,  or  during  one  of 
the  periods  of  remission,  fecundation  may  take  place.  When  the 
disease  is  further  advanced,  however,  many  causes  concur  to  render 
coitus  unfruitful.  Ejaculation  is  weak  and  precipitate,  so  that  the 
seminal  fluid  cannot  be  thrown  into  the  cavity  of  the  uterus  ;  it  is 
not  sufficient,  in  order  to  fecundate,  simply  to  spread  the  fluid  over 
the  vagina ;  it  must  be  projected  with  sufficient  force  to  pass  through 
the  orifice  of  the  uterine  neck.  Besides,  in  these  cases  the  erections, 
even  when  they  permit  sexual  intercourse,  are  incomplete  and  of 
very  short  duration  ;  emission  takes  place  without  energy  and  very 
soon ;  so  that  during  such  rapid  acts  the  uterus  and  Fallopian  tubes 
have  not  sufficient  time  for  their  office :  the  semen  itself  undergoes 
great  changes,  to  which  perhaps  the  loss  of  the  fecundating  power  is 
chiefly  attributable.  Microscopic  researches  have  elucidated  this 
formerly  obscure  subject ;  I  have  discovered,  for  instance,  that  the 


GENERAL    SYMPTOMS.  269 

spermatozoa  undergo  changes  similar  to  those  of  the  fluid  which 
serves  as  their  vehicle ;  these  changes  are  exceedingly  important, 
and  are  owing  to  defective  formation.  Spermatozoa  may  be  met  with 
in  a  less  thick  and  less  opaque  fluid  than  natural  for  they  are  not 
produced  by  the  same  parts,  or  in  the  same  manner ;  but  when  the 
secretion  is  perfectly  thin  and  watery,  the  functions  are  so  seriously 
aflfected  that  the  animalcules  are  altered ;  they  are  less  developed, 
less  opaque,  and  less  active  than  natural;  indeed,  they  are  so  trans- 
parent that  peculiar  precautions  are  necessary  in  order  to  make  sure 
of  seeing  them ;  their  motions  are  weak,  slow,  and  cease  very  soon  ; 
and  they  rapidly  undergo  decomposition.  All  these  characteristics 
show  how  much  their  texture  is  relaxed,  and  how  imperfectly  they 
are  organized. 

It  is  evident  that  the  least  arrest  of  development  in  the  sperma- 
tozoa must  prove  an  insurmountable  obstacle  to  fecundation,  even  if 
the  only  function  of  the  animalcules  be  to  carry  the  liquor  seminis 
to  the  ovum.  When,  however,  their  imperfect  development  only 
arises  from  a  too  rapid  formation,  it  may  soon  be  obviated.  It 
suffices  that  the  involuntary  discharges  should  cease  for  a  few  days 
only,  in  consequence  of  some  accidental  cause,  or  of  one  of  the  spon- 
taneous changes  of  this  extraordinary  disease,  in  order  for  the  desires 
to  become  more  lively,  the  erections  more  energetic  and  prolonged, 
and  for  the  function  to  be  accomplished  in  a  natural  manner.  Fe- 
cundation is,  therefore,  possible,  as  I  have  previously  stated,  during 
the  whole  duration  of  one  of  these  intermissions. 

This  is  not  the  case  when  the  spermatozoa  are  malformed,  rudi- 
mentary, more  or  less  deprived  of  tail,  &c.,  for  these  changes  only 
take  place  when  there  is  a  serious  alteration  in  the  structure  of  the 
testicles.  I  have  taken  every  opportunity  of  dissecting  the  testicles 
altered  in  these  cases,  and  I  have  always  found  the  secreting  struc- 
tures paler,  drier,  and  denser  than  natural,  and  the  cellular  tissue 
more  resisting,  and  with  difficulty  allowing  the  secreting  ducts  to  be 
separated  one  from  another.  Sometimes  half  or  two-thirds  of  the 
testicle  were  transformed  into  a  fibrous  or  fibro-cartilaginous  tissue, 
mixed  in  a  few  cases  with  tuberculous  matter,  to  experience  the 
excitement  necessary  to  carry  the  semen  to  its  destination  even 
when  it  passes  the  neck  of  the  uterus.  Nor  is  it  especially  in  the 
epididymis.  I  have  even  seen  traces  of  ossific  deposit  in  the  midst 
of  cartilaginous  indurations.  These  changes,  caused  by  previous 
inflammation,  perfectly  explain  why  the  development  of  the  sperma- 
tozoa can  no  longer  proceed  normally. 

Although  in  such  cases  the  secretion  of  semen  may  be  more  or  less 
diminished,  pollutions  may  still  be  present  if  the  seminal  vesicles  have 
shared  the  inflammation  by  which  the  testicles  have  been  aff'ected,  as 
happens  in  most  cases  of  orchitis  arising  from  blennorrhagia.  I  have 
at  present  a  patient  who  presents  a  remarkable  example  of  both  these 
efi'ects  arising  from  this  cause  :  he  is  now  forty-one  years  of  age, 
and  had  blennorrhagia  followed  by  inflammation  of  both  testicles  at 


270  SYMPTOMS    OF    SPERMATORRHOEA. 

twenty-five.  Soon  after  his  recovery,  he  married,  but  has  never  had 
children,  although  the  act  has  been  performed  regularly  if  not 
frequently.  He  became  subject  to  nocturnal,  and  sometimes  diurnal 
pollutions,  which  increased  by  degrees.  His  health  became  disor- 
dered, but  coitus  was  still  possible.  The  semen  passed,  although  it 
presented  its  characteristic  odor,  never  showed  under  the  microscope 
other  than  very  small  and  brilliant  globules  without  any  appearance 
of  tail,  but  easily  distinguishable  from  globules  of  mucus,  the  dimen- 
sions of  which  are  five  or  six  times  larger.  The  epididymis  of  both 
sides  is  voluminous  and  irregular.  One  testicle  is  adherent  to  the 
skin  of  the  scrotum,  and  the  other  appears  smaller  than  natural. 

Malformation  of  the  spermatozoa,  therefore,  arises  from  deep- 
seated  changes  in  the  tissues  of  the  testicles,  changes  which  do  not 
permit  the  animalcules  to  resume  their  normal  form,  and,  therefore, 
render  infecundity  permanent. 

To  sura  up,  then.  Involuntary  seminal  discharges  may  oppose 
fecundation  previously  to  actually  producing  impotence,  by  diminish- 
ing the  energy  of  all  the  phenomena  that  concur  to  the  accomplish- 
ment of  the  act,  and  by  preventing  the  complete  development  of  the 
spermatozoa,  as  well  as  the  elaboration  of  the  fluid  which  acts  as  the 
vehicle  for  them. 

These  conditions  may  be  rapidly  altered  by  the  simple  diminution 
of  the  involuntary  discharges,  and  fecundation  may  again  become 
possible. 

This  cannot  be  the  case  when  infecundity  depends  on  malforma- 
tion of  the  spermatozoa — such  malformation  arising  from  permanent 
alteration  in  the  organs  that  supply  them. 

Fever. — Whatever  may  be  its  characters,  fever  can  never  be  con- 
sidered as  a  symptom  of  involuntary  seminal  discharges — such  eva- 
cuations, however  serious  they  may  be,  never  producing  febrile  excite- 
ment. Patients  suffering  from  spermatorrhoea,  however,  are  not 
exempt  from  fevers  arising  from  other  causes ;  indeed,  they  become 
more  liable  in  consequence  of  their  constitutions  resisting  such  causes 
less  directly.  These  fevers  must,  therefore,  be  considered  as  acci- 
dental complications,  and  treated  as  such. 

Symptoms  affecting  the  Digestive  Organs. — At  first  venereal 
excesses  are  generally  accompanied  with  an  increased  appetite  from 
the  necessity  the  economy  experiences  of  making  up  its  daily  losses, 
and  from  the  excitement  of  the  genital  organs.  Masturbation  often 
produces  analogous  effects ;  sometimes,  too,  voracity  or  boulimia 
results  from  it. 

After  a  longer  or  shorter  time,  according  to  the  power  of  the 
stomach,  the  patient's  digestion  becomes  less  easy,  and  after  a  time 
very  laborious.  In  this  condition,  if  the  excesses  or  abuses  cease, 
the  disorder  of  the  digestive  organs  is  soon  repaired,  and  all  again 
becomes  natural.  This  cannot  take  place  when  once  involuntary 
discharges  have  supervened. 

Still  the  patients  continue  to  eat  as  usual,  or  even  more  than  usual, 
either  because  they  wish  to  repair  their  strength  by  abundant  and 


GENERAL    SYMPTOMS.  271 

succulent  food,  or  because  they  feel  a  real  appetite.  The  sensation 
experienced  in  the  latter  case  is  not  precisely  that  of  common  hun- 
ger ;  it  is,  rather,  a  sense  of  gnawing  and  heat,  referred  to  the  epi- 
gastrium, or  a  kind  of  uneasiness  or  sinking  which  sometimes  nearly 
causes  faintness.  A  small  quantity  of  food  puts  an  end  to  this  sen- 
sation, and  soon  afterwards  disgust  is  felt.  But  the  patients  compel 
themselves  to  eat  against  their  will,  or  they  increase  the  number  of 
their  meals  in  proportion  as  the  uneasiness  in  the  stomach  becomes 
more  frequently  repeated.  By  some  means  or  other  they  generally 
take  during  the  twenty-four  hours  more  food  than  their  stomachs  are 
able  to  digest. 

Almost  all,  too,  seek  the  most  spiced  and  most  savoury  kinds  of 
food,  and  take  alcoholic  drinks,  coffee,  &c.,  in  order  to  favor  the  di- 
gestive process.  But  these  dangerous  auxiliaries  cannot  restore  the 
original  vigor  to  their  digestive  organs  ;  they  only  beget  excitement, 
not  healthy  strength.  Hence,  the  illusions  produced  by  this  stimu- 
lating diet  are  not  of  long  duration.  Those  who  expected  the 
greatest  benefit  soon  find  their  digestion  more  difficult  and  painful ; 
they  have  thus  increased  the  irritation  of  the  stomach. 

A  constant  and  remarkable  increase  in  the  involuntary  discharges 
results  as  much  from  the  effects  such  excitants  produce  on  the  whole 
economy,  as  from  the  special  influence  of  the  stomach  on  the  sper- 
matic organs,  for  there  is  a  reciprocal  action  as  usual. 

In  perfect  health,  excitement  of  the  genital  organs  is  soon  fol- 
lowed by  increased  appetite  ;  and,  on  the  other  hand,  a  succulent 
meal  disposes  to  coitus  long  before  any  increased  secretion  of  semen 
can  result  from  it.  The  same  relations  exist  when  the  functions  are 
disordered,  for,  if  abundant  involuntary  discharges  provoke  painful 
sensations  in  the  stomach,  attacks  of  indigestion  equally  increase 
these  involuntary  discharges.  I  have  related  a  case  in  which  three 
relapses  occurred  during  convalescence  from  spermatorrhoea,  simply 
from  attacks  of  indigestion. 

Various  phenomena  of  considerable  importance  accompany  these 
indigestions.  The  meal  is  not  followed  by  that  vague  sense  of  com- 
fort which  attends  reparation  of  the  economy  ;  on  the  contrary,  a 
sense  of  weight  is  felt  in  the  epigastrium,  and  produces  a  degree  of 
uneasiness  and  of  restlessness  which  induces  the  patient  to  change 
his  position  :  the  pulse  is  quickened,  and  sometimes  beats  violently  ; 
the  face  flushed ;  confusion  of  ideas  follows,  with  noise  in  the  ears 
and  vertigo ;  and  sometimes  symptoms  of  cerebral  congestion  which 
may  proceed  so  far  as  to  induce  a  fear  of  apoplexy. 

An  increasing  degree  of  torpidity  succeeds  this  excitement  in  pro- 
portion as  the  disorder  of  the  stomach  becomes  more  fatiguing  ; 
hence  the  tendency  to  inactivity  and  sighing.  Besides  which,  acid 
eructations,  and  an  acrid  burning  heat  at  the  top  of  the  oesophagus, 
with  a  species  of  pyrosis,  sufficiently  point  out  how  disordered  is  the 
digestive  process. 

When  this  badly  formed  chyme  passes  into  the  duodenum,  it  pro- 


272  SYMPTOMS    OF    SPERMATORRH(EA. 

duces  abnormal  impressions  which  are  transmitted  to  the  liver  and 
pancreas  by  their  excretory  ducts ;  hence  the  secretions  of  these 
glands  are  altered.  The  digestive  process  carried  on  in  the  small 
intestine  is  thus  still  more  deranged  than  that  in  the  stomach  ;  hence 
arises  evolutions  of  flatus,  with  its  accompaniments,  colic,  griping,  &c. 
After  causing  borborygmi,  the  flatus  becomes  collected  in  the  stomach 
and  large  intestines  from  their  greater  size,  and  distends  them  fully 
on  account  of  the  laxity  of  their  muscular  coats.  Frequently  local 
spasmodic  contractions,  however,  oppose  the  passage  of  the  flatus, 
and  these  are  produced  by  the  irritation  of  the  mucous  membrane. 
Tlie  distension  is  most  marked  in  the  epigastric  and  hypochondriac 
regions,  from  the  stomach  and  colon  being  situated  in  those  locali- 
ties. Hence,  the  pressure  on  the  diaphragm  and  the  difficulty  of 
breathing,  as  well  as  the  constant  uneasiness  which  exists  in  the  parts 
until  the  flatus  has  been  expelled.  Hence  the  necessity  which  the 
patients  feel  of  passing  the  flatus  as  soon  as  possible,  and  the  dis- 
orders to  which  they  are  subject  when  any  circumstances  compel 
them  to  oppose  this  desire.  * 

The  dislike  such  patieri"ts  manifest  for  society  is  also  explained  by 
this  circumstance.  They  feel  the  necessity  of  being  alone  after  their 
meals,  in  order  to  be  perfectly  free  to  expel  the  flatus  without  shame. 

Independently,  too,  of  these  daily  inconveniences,  such  patients  are 
occasionally  exposed  to  very  severe  attacks  of  colic.  After  a  con- 
siderable collection  of  flatus  in  the  intestines,  a  kind  of  cramp  seizes 
on  the  cardiac  and  pyloric  extremities  of  the  stomach  and  the  ileo- 
caecal  valve,  or  on  some  other  part  of  the  intestine,  and  prevents  any 
passage  just  as  much  as  internal  strangulation.  The  distension  in- 
creases rapidly,  and  with  it  local  pain  and  difficulty  of  breathing. 
The  heart's  action  becomes  rapid  and  irregular  ;  the  patients  throw 
off"  their  clothes  ;  ihe  least  pressure  on  the  abdomen  is  insupportable ; 
they  feel  as  though  their  bowels  were  torn  or  dragged  ;  abundant 
perspiration  covers  their  faces,  and  indeed  their  whole  bodies.  In 
the  midst  of  this  torture,  however,  a  low  grumbling  shows  that  the 
flatus  is  making  a  passage,  the  spasmodic  contraction  becoming  re- 
laxed. The  pain  passes  off"  by  degrees,  and  the  attack  generally 
ends  in  the  expulsion  of  large  quantities  of  flatus. 

When  such  violent  attacks  only  continue  an  hour  or  so,  no  bad 
eff'ects  remain  ;  but  when  the  attacks  are  of  longer  duration  they  are 
followed  by  general  debility  during  several  days,  with  a  yellowish 
skin  and  more  marked  derangement  of  the  stomach,  with  a  notable 
increase  in  the  diurnal  pollutions. 

It  is  self-evident  that  the  frequent  return  of  these  colics  must 
affect  the  whole  system.  Thus  the  patients  dread  what  they  call 
their  "  crisis"  or  "  attacks  ;"  and  as  they  are  attributable  sometimes 
to  cold  and  sometimes  to  the  eff'ects  of  moral  emotion,  the  patients 
are  careful  to  avoid  these  causes.  Hence  their  lives  are  passed  in 
a  series  of  trifling  cares,  of  which  their  friends  cannot  understand 
the  necessity. 


GENEEAL    SYMPTOMS.  273 

Sometimes  too  such  patients  suffer  from  spasms  of  the  oesophagus, 
which  suddenly  prevent  deglutition,  especially  when  very  hot  or  very 
cold  drinks  are  taken.  A  complete  obstacle  is  thus  sometimes  put 
to  the  passage  of  any  matter,  fluid  or  solid,  during  several  minutes, 
just  as  though  a  knot  had  been  tied  in  the  oesophagus,  and  generally 
at  its  cardiac  extremity. 

There  is  not  only,  therefore,  diminution  of  the  digestive  powers, 
but  they  are  at  the  same  time  disordered.  The  organs  are  not  only 
weaker,  they  are  also  more  easily  deranged.  The  symptoms  vary 
much  in  different  individuals,  and  in  the  same  individual  on  different 
days.  Notwithstanding  the  patients'  endeavors  to  discover  the  causes 
of  these  variations,  the  most  important  one  generally  escapes  them  ; 
for  it  is  almost  always  the  occurrence  of  a  diurnal  pollution  that 
increases  their  digestive  disorder,  and  suddenly  alters  their  characters 
and  conduct. 

At  length  the  more  intelligent  of  these  patients  perceive  that  they 
eat  too  much;  that. certain  kinds  of  food  and  drink  do  not  suit  them  ; 
and  by  degrees,  they  impose  on  themselves  a  more  and  more  severe 
regimen.  They  begin  by  giving  up  food  of  high  flavor,  such  as 
game,  &c.,  then  nourishing  food,  as  meat ;  afterwards  lighter  kinds, 
as  vegetables ;  and  at  length  they  become  reduced  to  a  milk  diet 
only.  As  regards  fluids :  at  first  they  renounce  spirits,  coffee,  and 
tea  ;  afterwards  wine  ;  and  at  length  are  reduced  to  drink  water.  I 
have  met  with  several  patients  who  only  took  gum,  milk,  and  sugar, 
and  one  of  these  had  lived  on  such  food  two  years  when  he  con- 
sulted me.  By  this  rigorous  self-denial  they  escape  the  indiges- 
tion, &c.,  which  too  nutritive  food  produces  in  them,  but  they  are 
exposed  to  a  sense  of  sinking  in  the  stomach,  brought  on  frequently 
by  hunger,  and  they  are  also  frequently  annoyed  by  flatus.  In  these 
cases  it  is  no  longer  during  the  progress  of  digestion  that  the  flatus 
is  developed,  but,  on  the  contrary,  after  the  stomach  has  continued 
a  long  time  empty.  The  ingestion  of  a  small  quantity  of  food  soon 
relieves. 

Other  not  less  important  changes  take  place  at  the  lower  extremity 
of  the  digestive  canal.  Incomplete  digestion  brings  to  the  intestines 
badly  formed  chyme,  which  acts  irritatingly  on  the  mucous  surfaces, 
and  increases  their  secretion,  and  hence  arise  liquid  and  unnatural 
stools — a  kind  of  transient  diarrhoea  which  returns  with  every  slight 
imprudence.  The  diarrhoea  increasing  on  each  occasion  may  be- 
come permanently  established,  and  after  a  time  present  the  ordinary 
chronic  symptoms.  MM.  Fournier  and  Begin'  state  that  they  have 
seen  the  same  result  from  excessive  masturbation. 

Diarrhoea  kept  up  by  ulcerations  in  the  intestines  becomes  alto- 
gether an  idiopathic  disease,  the  indications  of  which  are  peculiar 
and  proportionably  urgent,  because  the  inflammation  of  the  rectum 

1  Dictionnaire  des  Sciences  Medicales.     Art.  Masturbation. 


274  SYMPTOMS    OF    SPERMATOEEHCEA. 

increases  the  diurnal  pollutions  by  its  action  on  the  seminal  vesi- 
cles :  hence  two  debilitating  diseases  arise  and  rapidly  increase  the 
wasting  of  the  body.  But  such  cases  are  rare,  and  are  only  no- 
ticed in  persons  who  do  not  check  their  voracious  appetites.*  These 
are  few. 

After  numerous  alternations  of  irritability  and  sluggishness  of  the 
intestines,  constipation  becomes  permanently  established,  and  grows 
more  and  more  obstinate ;  or,  at  all  events,  only  ceases  for  short 
periods  to  give  place  to  diarrhoea  after  some  error  of  diet.  Con- 
stipation, therefore,  almost  always  attends  old  cases  of  involuntary 
seminal  discharge,  and  contributes  to  maintain  the  pollutions. 

The  influence  of  this  constipation  is  still  more  injurious  than  that 
of  the  stomach  disorder,  and  hence  the  patients  soon  discover  that 
there  is  a  constant  relation  between  the  act  of  defecatioYi  and  all  they 
suffer  from.  They  are  perfectly  aware  that  with  soft,  easy,  and 
regular  stools  their  strength  returns,  and  their  activity  increases, 
their  sensations  are  more  lively,  and  their  ideas  clearer.  Experience 
soon  shows  them  the  bad  effects  of  long  constipation  :  they  are  de- 
bilitated after  laborious  attempts  at  defecation.  They  are,  however, 
for  the  most  part  ignorant  that  abundant  diurnal  pollutions  result, 
although  the  constant  repetition  of  the  same  phenomena  at  length 
fixes  their  attention  on  the  importance  of  defecation,  and  that  func- 
tion absorbs  all  their  attention.  Hence  they  are  constantly  occupied 
in  seeking  laxative  food,  slightly  aperient  medicines,  enemata, 
&c.,  and  frequently  speak  of  these  things  from,  habit,  and  without 
considering  the  effects  of  such  conversation  on  others.  The  further 
we  advance,  then,  the  more  we  find  that  these  general  symptoms  of 
involuntary  seminal  discharges  are  those  which  have  been  generally 
described  as  hypochondriasis.  It  is  evident  also,  that,  according  to 
the  predominance  of  certain  symptoms,  our  profession  have  usually 
been  in  the  habit  of  diagnosing  pyrosis,  disorder  of  the  liver,  nervous- 
ness, chronic  gastritis,  or  gastro-enteritis,  &c.,  in  these  cases.  There 
is  considerable  correctness  in  these  diagnoses ;  but  the  futility 
of  the  treatment  shows  that  the  cause  is  very  frequently  unascer- 
tained. 

Nutrition. — The  whole  economy  necessarily  soon  feels  the  effects 
of  serious  digestive  disorder;  for  the  condition  most  essential  to 
nutrition  is  good  digestion.  The  phenomena  which  follow  meals  in 
such  cases  show  clearly  enough  that  digestion  is  incomplete  ;  absorp- 
tion can,  therefore,  obtain  only  little  reparative  matter  from  a  mix- 
ture of  useless  or  even  injurious  material :  hence  the  structures  of  the 
body  necessarily  lose  substance,  and  the  functions  languish.  Not 
only  does  the  embonpoint  diminish,  but  also  the  energy  and  activity 
of  all  the  organs ;  for  it  is  necessary  that  all,  in  order  to  act  well, 
should  constantly  receive  a  supply  of  rich  blood. 

Still,  however,  it  is  far  from  an  invariable  rule  that  patients  suffering 
from  involuntary  seminal  discharges  should  be  emaciated,  or  that  they 
should  all  have  a  yellow  or  leaden  appearance,  or  sunken  hollow  eyes. 


GENERAL    SYMPTOMS.  275 

Many  even  preserve  their  embonpoint^  fresh  color  and  healthful  ap- 
pearance, although  they  may  be  impotent,  weak,  and  troubled  with 
considerable  disorders  ;  and  although  they  may  even  contemplate 
suicide.  These  are  the  patients  who  are  considered  as  malades  ima- 
ginaires,  whose  friends  wish  to  marry  them  against  their  will,  in  order 
to  draw  them  out  of  their  isolation  and  melancholy.  The  constant 
persecution  of  their  friends  and  relations  increases  the  unhappiness 
of  such  patients  by  recalling  to  their  recollection  the  bitter  truth 
v/hich  they  are  unwilling  to  confess.  Often  have  I  heard  these 
patients  complain — "  0  that  I  were  thin  and  yellow,  that  I  had  the 
appearance  of  a  sick  person  ;  I  should  then  be  pitied  and  permitted 
to  follow  my  own  inclinations." 

Whence  arise  such  apparent  anomalies  ?  From  congenital  predis- 
position. The  digestive  organs  of  some  individuals  are  sufficiently 
strong  to  resist  the  influence  of  involuntary  discharges,  which  on  the 
other  hand,  seriously  disorder  all  their  other  functions.  There  are 
others  again  whose  assimilative  powers  are  so  active  that  the  strictest 
diet  is  necessary  in  order  to  prevent  extreme  corpulency;  others  too 
who  are  of  marked  sanguineous  temperament  never  lose  the  redness 
of  their  cheeks  and  the  size  of  their  muscles. 

Animal  Heat. — As  soon  as  the  digestion  becomes  deranc^ed  and 
the  evihonpoint  decreases,  the  patients  become  more  sensible  to  the 
influence  of  cold.  They  soon  find  that  they  must  clothe  themselves 
more  warmly,  keep  out  of  draughts,  and  use  increased  precautions  of 
every  kind,  in  order  to  prevent  pains  in  the  limbs,  catarrhal  afl'ec- 
tions,  &c.  But  being  very  warmly  clothed  they  are  unable  to  take 
any  active  exercise  without  being  covered  with  perspiration,  which 
comes  on  very  rapidly.  On  the  other  hand,  again,  warmth  durino- 
the  night  exposes  them  to  the  occurrence  of  pollutions.  They  are, 
therefore,  continually  endeavoring  to  reconcile  these  difficulties,  and 
the  importance  they  attach  to  trifling  circumstances  appears  ridicu- 
lous to  an  uninterested  spectator. 

It  is  evident  then  that  the  weakening  of  the  body  and  its  incom- 
plete repair,  by  means  of  badly  formed  matter,  renders  such  patients 
more  easily  affected  by  the  action  of  external  agencies.  Being  de- 
bilitated they  are  more  exposed  to  disease  than  other  people,  and 
the  complaints  that  aff'ect  them  are  less  quickly  cured,  and,  indeed, 
often  pass  into  a  chronic  state. 

To  the  diminution  of  the  nutritive  powers  must  be  attributed  the 
early  loss  of  hair  which  many  of  such  patients  experience,  and  which 
equally  follows  all  diseases  capable  of  producing  serious  disorder  of 
the  economy. 

The  voice  too  is  much  afi'ected  by  every  prolonged  action  capable 
of  debilitating  the  economy  ;  and  it  is  not,  therefore,  remarkable  that 
it  should  often  lose  its  power  and  quality  of  tone  in  these  patients. 
But  the  voice  is  not  only  low  and  husky ;  it  presents  a  degree  of 
uncertainty  of  tone  which  doubtless  arises  from  the  agitation  the 


276  SYMPTOMS    OF    SPERMATORRHCEA. 

patients  constantly  experience.     The  least  emotion  too  makes  them 
stammer. 

Respiration. — Not  only  while  running  or  ascending  a  hill  or  stairs, 
hut  even  on  taking  very  slight  exercise,  patients  affected  with  sper- 
matorrhoea become  out  of  breath ;  sometimes,  even,  they  feel  op- 
pressed breathing  during  absolute  quiescence ;  they  frequently  sigh 
also.  These  symptoms,  however,  are  by  no  means  always  well 
marked.  The  same  thing  occurs  with  regard  to  the  respiratory  as 
in  all  the  other  systems.  Variations  take  place  in  accordance  with 
the  constitution  of  the  individual.  These  phenomena  are  produced 
in  the  following  manner  : — 

The  muscles  which  perform  the  function  of  respiration,  participating 
in  the  general  debility  of  the  system,  contract  less  energetically  and 
less  frequently  than  natural ;  the  respirations,  therefore,  become 
shorter  and  less  frequent :  hence  the  necessary  changes  in  the  blood 
are  not  properly  performed,  and  there  is  defective  equilibrium  be- 
tween the  respiration  and  circulation,  with  habitual  sense  of  uneasi- 
ness and  oppression  in  the  chest.  Hence  arises  the  necessity  for 
deep  voluntary  inspirations  or  sighs,  to  re-establish  this  equilibrium 
occasionally,  and  to  fill  the  extreme  pulmonary  vesicles  with  air. 
The  patients  are  apt  to  call  these  sighs  involuntary,  because  they  are 
forced  to  make  them  without  knowing  why.  On  the  other  hand, 
again,  being  deeply  afflicted  at  their  condition,  and  incessantly  occu- 
pied in  seeking  its  cause,  the  patients  sometimes  suspend  the  motions 
of  the  thorax,  and  this  habit  increases  their  habitual  oppression. 
Lastly,  it  is  necessary  to  take  into  account  the  influence  of  the  pul- 
monic nervous  system.  It  is  not  probable  that  the  pulmonary  nerves 
should  escape  the  generally  debilitating  influence  of  involuntary 
discharges.  Dr.  Deslandes  indeed  thinks  that  the  nervous  asthma 
may  be  produced  by  masturbation  and  venereal  excesses,  inasmuch 
as  these  attacks  only  seem  to  him  to  be  aggravations  of  their  ordi- 
nary symptoms.  This  opinion  is  strongly  supported  by  what  I  have 
seen  in  many  patients.  The  effects  of  exercise  are  the  same  in  these 
as  in  all  other  cases  of  extreme  debility. 

Patients  suffering  from  spermatorrhoea  often  experience  other 
symptoms  of  which  it  is  necessary  to  be  aware.  Sometimes  they 
have  a  predisposition  to  pulmonary  catarrh,  with  coryza,  loss  of 
voice,  &c. ;  in  other  cases  there  is  a  constant  dry  cough  ;  in  others, 
again,  fixed  or  wandering  pains  in  the  thorax ;  and  in  a  few  cases  a 
sudden  pain  seizes  on  the  heart  or  diaphragm,  and  for  a  minute  or 
two  causes  great  agony.  Most  of  the  patients  whose  respiratory  ap- 
paratus is  thus  disordered  believe  themselves  the  subjects  of  phthisis. 
The  symptoms,  however,  only  differ  in  situation  from  the  other  nu- 
merous irritations  and  pains  which  successively  attack  all  parts  of 
their  bodies. 

Circulation. — The  disorders  of  the  circulating  system  in  these  cases 
may  give  rise  to  errors  of  much  importance.    I  have  seen  more  than 


GENERAL    SYMPTOMS.  277 

thirty  of  these  patients  wYiO  had  been  long  treated  for  disease  of  the 
heart  of  which  there  did  not  exist  the  least  traces.  The  symptoms 
which  had  increased  after  every  bleeding  disappeared  as  soon  as  the 
involuntary  discharges  were  arrested.  It  is  indisputable  that  abuse, 
venereal  excesses,  and  involuntary  discharges  often  excite  more  or 
less  alarming  palpitations  ;  but  can  we  attribute  the  origin  of  organic 
diseases  of  the  heart  to  such  causes  ? 

Even  when  an  organic  lesion  of  the  heart  or  large  vessels  does 
occur  in  a  patient  who  has  practised  masturbation,  or  committed  ve- 
nereal excesses,  is  it  necessary  that  the  disease  be  referred  to  these 
causes  alone?  Certainly  not :  for  among  the  immense  number  of 
those  who  are  exposed  to  the  debilitating  action  of  these  causes  it  is 
unreasonable  to  expect  that  none  should  be  found  with  cardiac  dis- 
ease. I  admit,  however,  that  the  momentarily  increased  rapidity  of 
the  circulation  may  aggravate  organic  diseases  already  existing;  but 
certainly  the  diseases  themselves  would  be  much  more  frequent  if 
they  could  be  brought  on  by  such  common  causes. 

The  functional  derangement  of  the  circulation  is,  however,  some- 
times so  alarming  and  long  continued  that  it  may  be  easily  mistaken 
for  an  idiopathic  disease  ;  but  these  symptoms  are  more  common  in 
children  than  in  adults,  and  in  adults  than  in  persons  of  mature  age 
— a  circumstance  which  alone  is  sufficient  to  show  that  the  symptoms 
do  not  arise  from  organic  lesion  of  the  heart  or  large  vessels.  The 
same  remarks  apply  to  involuntary  seminal  discharges. 

Five  of  my  patients  had  never  committed  any  abuse  or  remarkable 
excess.  One  of  them  fell  into  the  sea  in  very  cold  weather;  another 
was  exposed  to  cold  in  helping  to  extinguish  a  fire ;  a  third  had  used 
constant  horse  exercise ;  and  the  two  others  had  only  suffered  from 
blennorrhagia,  yet  all  five  experienced  such  palpitations  of  the  heart 
that  their  attendants  had  not  doubted  the  existence  of  an  organic 
lesion.  This  palpitation,  however,  was  purely  nervous,  and  could 
not  even  be  attributed  to  the  perturbation  of  the  circulatory  system 
during  voluntary  seminal  discharges. 

It  is  to  the  debility  and  disorder  of  the  system,  and  especially  to 
the  disorder  of  the  nervous  system,  that  these  symptoms  must  be 
referred.  As  a  proof  of  this  there  is  the  fact  that  they  may  be  pro- 
duced by  any  other  debilitating  causes ;  whilst  they  are  never  ob- 
served in  robust  individuals  who  take  even  the  most  violent  exercise. 

It  may  be  supposed  that  nervous  palpitations  would  be  distin- 
guished with  difficulty  from  organic  diseases  of  the  heart :  such  is 
not  the  case,  however.  In  organic  diseases  of  the  heart  the  face  is 
habitually  injected,  the  lips  and  tongue  are  violet-colored  from  the 
obstruction  to  the  venous  circulation.  Nothing  similar  occurs  in 
nervous  palpitation.  If  the  cheeks  become  injected  occasionally,  they 
are  red,  and  the  injection  soon  passes  ofi",  the  face  resuming  its  na- 
tural tint  afterwards.  In  either  hypertrophy  or  dilatation  the  pul- 
sations are  always  proportioned  in  strength  and  frequency  to  the 
motions  of  the  patient,  because  the  obstruction  to  the  circulation, 
18 


278  SYMPTOMS    OF    SPEKMATORRHfEA. 

whatever  may  be  its  seat  or  nature,  is  permanent ;  whilst  the  quan- 
tity of  blood  driven  towards  the  heart  increases  in  proportion  to  the 
muscular  efforts.  The  primary  cause  of  such  palpitations  being 
therefore  in  constant  action,  the  secondary  one  must  always  produce 
effects  in  proportion  to  its  intensity. 

Nervous  palpitations  are  far  from  following  the  same  course.  It 
is  true  that  the  least  motion  often  increases  them  to  an  alarming 
extent,  but  this  is  by  no  means  either  constant  or  in  proportion  to 
the  muscular  efforts.  At  one  time  active  and  long  continued  exercise 
may  produce  no  more  effects  than  in  a  healthy  individual  ;  whilst 
at  another,  sudden  and  violent  disorder  may  come  on,  even  when 
the  body  is  in  a  state  of  repose,  either  from  the  sight  of  an  unex- 
pected object,  from  a  sudden  noise,  or  from  the  passage  through  the 
mind  of  an  involuntary  idea. 

We  see,  therefore,  that  a  superficial  examination  is  sufficient  to 
point  out  the  difference  between  organic  and  functional  diseases  of 
the  heart.     Physical  exploration  is  of  course  more  certain. 

INNERVATION. 

Motility. — The  weakness  of  patients  suffering  from  involuntary 
seminal  discharges  does  not  arise  from  their  loss  of  flesh  only.  Many 
of  them  possess  embonpoint,  healthy  appearance,  and  even  volumi- 
nous muscles,  although  quite  unable  to  bear  active  and  prolonged 
exercise.  Debility  always  precedes  the  loss  of  flesh  :  it  is  invariable 
and  marked  ;  but  at  the  same  time  disappears  very  quickly.  When 
the  patients  have  passed  a  few  days  in  succession,  without  suffering 
from  pollutions,  they  manifest  rapid  increase  of  strength  and  acti- 
vity :  a  single  discharge  again  reducing  them  to  their  debilitated 
condition.  The  weakness  of  their  muscles,  therefore,  depends  on  a 
cause  distinct  from  atrophy  ;  it  arises  from  flaccidity.  Let  us  con- 
sider how  this  weakness  is  produced. 

Masturbation  is  generally  commenced  before  puberty,  and  the  fe- 
male sex  is  not  exempt  from  it.  In  these  cases,  therefore,  seminal 
emission  cannot  occur.  Nevertheless,  functional  disorders  of  the 
spinal  cord  may  arise,  similar  to  those  produced  by  passive  discharges. 

I  have  related  at  page  153  the  case  of  a  boy,  eight  years  of  age, 
whose  lower  extremities  were  bent  and  drawn  together,  and  in  a  state 
of  paralysis,  or  rather  of  contraction,  which  prevented  their  use. 
This  state  ceased  entirely  a  few  days  after  masturbation  had  been 
completely  prevented,  the  cure  not  being  assisted  by  any  other  ex- 
ternal or  internal  treatment.  I  have  met  with  several  such  cases  in 
children  before  the  age  of  puberty,  and  I  should  add  that  in  most 
of  them  the  arms  were  pressed  against  the  body,  the  forearms  bent 
on  the  arras  and  crossed  on  the  breast,  the  fingers  stiff,  &c. 

On  the  other  hand,  again,  I  have  seen  patients  from  thirty  to  forty- 
five  years  of  age  who  had  fallen  into  a  similar  condition  from  diurnal 
pollutions.     Almost  all  had  had  leeches,  cupping  glasses,  and  issues 


GENERAL    SYMPTOMS.  279 

t 

not  only  on  the  loins  but  along  the  whole  length  of  the  vertebral 
column  :  all  had  found  bad  results  from  these  means  ;  whilst  the 
cessation  of  seminal  discharges  was  immediately  followed  by  free 
use  of  the  extremities. 

The  most  passive  pollutions  act,  therefore,  on  the  nervous  system, 
just  as  the  most  convulsive  voluptuous  sensations  not  followed  by 
seminal  emissions;  and  the  disordered  powers  of  the  lower  extremities 
no  more  depend  on  the  existence  of  organic  disease  of  the  spinal 
cord,  than  palpitations  depend  on  organic  disease  of  the  heart. 
There  are,  however,  many  intermediate  shades  between  this  extreme 
condition  and  ordinary  cases.  On  the  other  hand,  there  is  not  only 
muscular  debility  in  such  extreme  cases,  there  are  also  stiffness  and 
involuntary  contraction  of  the  muscles.  It  is  not  only  in  the  lower 
extremities,  too,  that  the  symptoms  are  manifested,  but  throughout 
the  whole  muscular  system. 

In  many  cases,  there  is  more  irregularity  and  disorder  than  actual 
weakness  in  the  muscular  system,  and  hence  many  such  patients  suffer 
from  involuntary  trembling  and  uncertainty,  with  a  loss  of  precision 
in  their  motions  that  renders  them  awkward.     Any  slightly  continued 
action   induces   trembling,   to    control   which  they  have  no   power. 
These  tremblings  resemble  the  mercurial  palsy  of  gilders,  or  the  deli- 
rium tremens  of  drunkards.     Hence  many  authors  believe  with  rea- 
son, that  masturbation  and  venereal  excesses  are  two  of  the  most  fre- 
quent causes  of  chorea.     Epilepsy  even,  may  be  induced — the  same 
phenomena  becoming  more  violent  but  less  continuous.     Epilepsy  is 
brought  on  much  more  frequently  by  masturbation  than  by  venereal 
excesses,  probably  for  the  following  reason.     Venereal  excesses  ge- 
nerally take  place  later  in  life  than  masturbation,  consequently  the 
constitution  is  stronger.     Cases  of  epilepsy,  too,  are  more  frequent 
after  masturbation,  in  proportion  to  the  youth  of  the  parties.     The 
same  thing  holds  good  with  regard  to  all  the  other  nervous  symptoms 
produced  by  masturbation,  and,  indeed,  with  all  nervous  symptoms, 
whatever  may  have  been  their  cause.     Here  we  again  see  the  great 
importance  of  taking  the  state  of  the  system  into  consideration  in  all 
these  cases,  in  order  to  appreciate  the  different  results  that  may  arise. 
Sensation. — There  are  other  nervous  symptoms  which  seem  the 
counterpart  of  those  happening  in  the  muscular  system.     I  have  met 
with  two  patients  in  whom  the  hands  were  insensible,  and  the  hands 
only  :  in  these  cases,  accidental  burns  took  place  without  causing 
pain  ;  but  the  motions  were  perfectly  free.     Other  patients  that  I 
have  seen,  experienced  a  diminution  of  touch  only  ;  a  layer  of  gauze 
seeming   to   be  interposed  between  the  object  and  the  fingers.     In 
other  cases,  one  side  of  the  chest  or  abdomen  was  more  or  less  de- 
prived of  sensation  ;  or  perhaps  a  circumscribed  portion  of  the  skin 
either  on  the  trunk  or  extremities.     This  anesthesia  changes  its  po- 
sition and  character  frequently — quite  enough  to  show  that  it  does 
not   arise   from   any  organic   lesion    of  the  spinal   cord  or   nerves. 
Other  patients  experience  disorders  of  sensation,  varying  greatly  in 


280  SYMPTOMS    OF    SPERMATORRHOEA. 

their  character  and  seat,  not  only  in  different  individuals,  but  in  the 
same  person  at  different  times.  Sometimes  there  is  a  sensation  of 
local  heat  or  burning;  at  others,  a  kind  of  current  which  seems  as 
if  caused  by  the  air,  by  water,  or  by  electricity  ;  or  there  may  be  a 
feeling  of  bruises,  cold,  or  pressure,  affecting  the  back  and  loins. 

Hippocrates  described  another  sensation  which  I  expected  to  find 
very  frequently.  I  allude  to  the  feeling  of  ants  running  along  the 
vertebral  column.  I  expected  to  find  this  symptom  very  common  in 
cases  of  spermatorrhoea,  but  I  have  hardly  met  with  it  in  one  case 
out  of  twenty.  Nervous  pains,  often  confounded  with  wandering 
rheumatism  on  account  of  their  uncertain  seat,  are  met  with  much 
more  frequently.  They  differ  from  rheumatism  in  not  being  caused 
by  cold  or  damp,  and  in  not  being  especially  seated  in  the  joints. 
The  patients  generally  suffer  most  from  these  pains  on  rising  in  the 
morning.  They  generally  follow  the  course  of  a  nerve,  and  some- 
times resemble  electric  shocks.  These  characteristics  are  sufficient 
to  distinguish  such  pains  from  rheumatism. 

The  loins  are  especially  the  seat  of  these  pains.  They  are  not  so 
acute  as  those  that  arise  from  lumbago  or  a  violent  muscular  effort, 
but  they  continue  longer.  Some  of  my  patients  had  been  teased  by 
them  for  many  years,  almost  continuously.  Their  seat  is  not  in  the 
muscles,  for  the  motions  of  the  spinal  column  are  not  affected ;  they 
are  not  caused  by  the  kidneys,  for  they  do  not  pass  in  the  course  of 
the  ureters — the  testicles  are  not  retracted,  and  the  urine  is  not 
purulent — symptoms  by  which  affections  of  the  kidneys  accompany- 
ing spermatorrhoea  may  be  easily  distinguished.  It  seems,  there- 
fore, that  these  pains  must  be  especially  referred  to  the  nerves  sup- 
plying the  lumbar  region. 

It  is  diflScult  to  doubt  the  existence  of  a  special  sympathy  between 
the  genital  organs  and  the  spinal  cord,  when  we  take  into  conside- 
ration the  influence  of  flagellation,  urtication,  &c.,  applied  on  the 
loins  ;  the  frequent  nocturnal  pollutions  excited  by  heat  of  this  re- 
gion and  the  opposite  effects  of  cold.  On  the  other  hand,  again,  this 
influence  is  reciprocal,  for  it  is  after  abundant  pollutions  that  the 
pains  in  question  occur  or  increase,  and  it  is  of  this  region  that 
patients  complain,  who  have  committed  excessive  abuse  or  venereal 
intercourse,  or  who  have  suffered  several  pollutions  in  one  night. 

SENSES. 

Taste. — The  changes  experienced  by  these  patients  in  the  organs 
of  taste  correspond  with  those  that  are  going  on  in  the  digestive 
organs.  In  some  the  appetite  is  disordered  from  the  first,  and  when 
the  disease  has  made  considerable  progress,  the  mouth  is  often  clammy 
with  a  bitter,  salt,  or  earthy  taste.  Food  and  drink  appear  less 
sapid,  and  do  not  give  any  agreeable  sensation.  Under  these  cir- 
cumstances the  patients  generally  restrict  themselves  spontaneously 
to  a  vegetable  diet,  or  even  to  milk. 


GENERAL    SYMPTOMS.  281 

Smell. — I  have  paid  little  attention  to  the  alterations  of  this  func- 
tion in  these  patients  ;  but  I  have  heard  many  complain  of  a  notable 
change  in  their  power  of  appreciating  odors,  and  even  of  an  entire 
loss  of  the  sense  of  smell. 

Hearing. — The  sense  of  hearing  suffers  more  changes  than  the 
preceding.  In  general,  like  the  others,  it  loses  its  acuteness,  and 
this  loss  sometimes  approaches  a  state  of  deafness.  These  symp- 
toms vary,  too,  according  to  the  individuals  affected,  and  the  differ- 
ent decrees  and  oscillations  of  the  disease,  and  even  sometimes  from 
day  to  day,  without  appreciable  cause. 

Some  patients,  again,  seem  to  possess  an  extreme  sensibility  of 
hearing — the  least  noise  irritates  them,  especially  if  continued  so 
that  they  cannot  put  a  stop  to  it.  It  seems,  however,  that  this 
symptom  must  be  referred  to  the  change  that  has  taken  place  in  the 
character  of  the  patients.  It  is  not  because  the  organ  has  become 
more  acutely  sensible  that  it  is  offended,  for  these  patients  do  not 
hear  better  than  other  people,  and  the  most  harmonious  sounds  pro- 
duce just  the  same  feeling  of  impatience  when  slightly  prolonged. 

Another  annoyance  felt  by  such  patients  results  from  the  different 
noises  they  have  in  their  ears.  In  some  there  is  a  constant  whist- 
ling ;  in  others,  a  sullen  rumbling  like  the  distant  roll  of.  the  drum  ; 
in  others,  again,  the  noise  resembles  that  of  a  waterfall,  mill,  &c. 
Some  patients  hear  many  of  these  noises  at  the  same  time.  Deaf- 
ness or  difficulty  of  hearing  accompanies  these  sounds.  In  propor- 
tion, therefore,  as  the  normal  functions  of  the  auditory  apparatus 
become  weak,  its  pathological  susceptibility  augments. 

Sight. — The  first  change  produced  by  involuntary  seminal  dis- 
charges is  a  diminished  brilliancy  of  the  eyes.  These  organs  soon 
lose  their  brilliant,  piercing  expression,  and  appear  dull,  although 
they  may  not  yet  be  either  sunken,  or  surrounded  by  dark  circles. 
There  is  always  more  or  less  marked  dilatation  of  the  pupils  under 
these  circumstances,  and  this  probably  conduces  to  give  the  eyes 
their  singular  appearance. 

To  the  want  of  expression  there  is  also  joined  a  timidity  or  ap- 
pearance of  shame,  especially  in  such  as  practise  masturbation. 
Their  eyes  never  meet  those  of  another  with  confidence ;  they  are 
turned  away  hastily,  and  after  wandering  about,  are  at  length  di- 
rected to  the  ground.  There  is  in  this  uncertainty  of  the  organs  of 
vision  something  analogous  to  the  trembling  of  the  voice,  hesitation 
of  speech,  stuttering  produced  by  emotion,  and  instability  of  the 
lower  extremities,  habitual  agitation  of  the  hands,  palpitation,  &c. — 
all  common  symptoms  in  these  cases.  Importance  attaches  to  these 
circumstances,  because  we  frequently  meet  with  patients  who  wish 
to  conceal  bad  habits,  besides  which,  most  of  those  who  suffer  from 
diurnal  pollutions  are  not  aware  of  their  existence. 

In  order  that  the  eyes  should  become  sunken  and  hollow,  emacia- 
tion must  have  made  considerable  progress,  and  this  emaciation  may 
depend  on  various  causes.     On  the  other  hand,  the  eyes  may  be  sur- 


282  SYMPTOMS    OF    SPERMATOKRH(EA. 

rounded  with  dark  circles  in  consequence  of  recent  abuse  or  excesses, 
althouf^h  the  health  may  not  be  disordered;  fatigue  and  want  of  sleep 
induce  the  same  results.  The  conjunctiva  is  sometimes  disposed  to 
become  injected  from  slight  causes  in  these  patients,  but  this  is  not 
a  very  constant  symptom.  Most  of  them  present  a  dull  and  wan- 
derinty  eye,  with  a  vacant  expression,  and  these  symptoms  increase 
with  the  disease,  and  follow  all  its  oscillations.  Sometimes,  too, 
the  patients  complain  of  involuntary  contraction  of  the  muscles  of 
the  eye  ;  now  and  then  there  is  spasmodic  trembling  of  the  upper 
ird  ;  at  other  times,  the  orbiculares  and  corrugatores  superciliorum 
contract  spasmodically  ;  at  other  times,  again,  the  muscles  of  the 
eyeball  enter  into  disordered  action,  and  produce  strabismus. 
These  symptoms  are  especially  observed  in  nervous  patients  who 
lead  a  sedentary  life,  and  use  their  eyes  much. 

At  the  same  time  that  the  previously  described  symptoms  show 
thetaselves,  the  patient's  vision  becomes  disordered  ;  first  at  varying 
intervals  ;  afterwards,  continuously.  The  sight  becomes  progres- 
sively weaker ;  small  objects  are  defined  with  less  clearness,  and 
seem  to  shake,  probably  from  want  of  precision  in  the  contraction  of 
the  recti  muscles.  The  patients  are  unable  to  fix  their  eyes  on  mi- 
nute objects  without  soon  experiencing  fatigue,  headache,  vertigo, 
and  congestion  of  the  head.  After  reading  for  a  short  time,  the  lines 
seem  to  oscillate,  and  the  words  become  confused.  More  or  less 
marked  diplopia  is  momentarily  established — probably  arising  from 
divergence  of  the  visual  axes  caused  by  unequal  contraction  of  the 
motor  muscles.  Other  patients,  again,  see  spots,  cobwebs,  or  flying 
points,  which  are  constantly  in  motion  before  their  eyes  ;  then  sud- 
denly, they  only  see  a  portion  of  the  objects  looked  at ;  perhaps  all 
on  the  left  or  right  side,  or  all  the  upper  or  lower  half,  or  sometimes 
the  centre  or  circumference;  the  remainder  disappearing  completely 
for  several  minutes,  half  an  hour,  or  perhaps  an  hour. 

Both  eyes  are  rarely  affected  in  this  way  at  the  same  time ;  when 
this  happens,  however,  the  disorder  of  vision  is  almost  as  serious  as 
if  complete  blindness  were  momentarily  established. 

These  nervous  disorders  are  frequently  accompanied  with  cepha- 
lalgia, vertigo,  noise  in  the  ears,  coldness  of  the  extremities,  vomit- 
ing, &c.,  and  sometimes  syncope  occurs.  The  patients  are  natu- 
rally much  alarmed  at  these  accidents,  although  they  do  not  last 
long,  and  the  practitioners  consulted  seldom  fail  to  diagnose  conges- 
tion of  the  brain,  and  to  practise  abstraction  of  blood.  This  error 
arises  from  certain  symptoms  being  regarded  singly  ;  if  the  accom- 
panying phenomena  were  taken  into  account,  and  especially  the 
general  state  of  the  economy,  it  would  become  evident  that  all  the 
symptoms  resemble  one  another,  and  that  they  all  depend  on  the 
nervous  system  ;  if,  therefore,  the  origin  of  the  nervous  disorder 
were  not  discovered,  at  least  the  symptoms  would  not  be  aggravated 
by  the  abstraction  of  the  blood. 

Independently  of  these  momentary  and  partial  attacks  of  paralysis 


GENERAL    SYMPTOMS.  283- 

of  the  retina,  this  organ  by  degrees  loses  its  sensibility,  the  pupil  at 
the  same  time  becoming  dilated.  Small  and  delicate  objects  are 
distinguished  less  clearly,  and  slightly  continued  attention  brings 
fatigue.  This  weakening  of  the  sight  is  one  of  the  most  constant 
effects  of  masturbation,  venereal  excesses  and  involuntary  discharges; 
it  follows  the  loss  of  brightness  in  the  eye  and  of  firmness  in  the  ex- 
pression ;  and  it  is  one  of  the  most  certain  signs  of  abuse. 

The  disorder  of  the  sight,  like  all  the  other  general  symptoms, 
varies  in  different  individuals,  and  at  different  periods  of  the  disease. 
In  the  worst  cases  complete  blindness  may  be  established.  Of  this 
I  have  recently  seen  a  very  remarkable  example.  Amaurosis 
brought  on  by  masturbation  or  venereal  excesses  has  long  been  re- 
cognized by  writers  on  diseases  of  the  eye,  and  if  they  have  omitted 
to  mention  the  amaurosis  arising  from  involuntary  seminal  discharges 
the  explanation  must  be  referred  to  their  ignorance  of  the  occur- 
rence of  such  discharges. 

It  has  been  generally  admitted  by  writers  on  the  eye,  that  amau- 
rosis caused  by  masturbation,  or  venereal  excesses,  is  very  difficult 
of  cure  ;  the  reverse  obtains.  Amaurosis  is  always  a  very  obstinate 
disease  when  .its  cause  is  unknown.  If  the  functions  of  the  optic 
nerves  are  impaired  by  cerebral  disease,  by  serous  effusion,  tumors, 
disease  of  the  meninges,  or  of  the  bones  of  the  head,  it  is  evident 
that  the  organs  cannot  be  readily  restored  to  their  normal  condition, 
even  when  an  exact  knowledge  has  been  obtained  of  the  seat  and 
nature  of  the  disease.  Unfortunately  numerous  amauroses  are  due 
to  causes  of  this  nature.  But  when  the  amaurosis  arises  from  an 
easily  discoverable  cause  and  one  easily  removed,  the  results  are 
different.  Thus,  I  have  on  two  occasions  seen  almost  complete 
blindness  disappear  by  degrees,  after  the  relief  of  diurnal  pollu- 
tions, which  kept  it  up.  Nocturnal  pollutions  alone  do  not  produce 
such  marked  effects,  because  they  are  far  from  being  so  serious  ;  but 
they  often  cause  considerable  weakening  of  sight.  In  cases  of  this 
nature  I  have  always  seen  the  ocular  functions  restored  after  the 
cure  of  involuntary  discharges ;  and  I  have  obtained  similar  results 
in  cases  which  arose  from  masturbation  and  venereal  excesses  by 
inducing  the  patients  to  alter  their  habits. 

On  the  other  hand,  other  patients  experience  very  different  symp- 
toms. Some  are  painfully  affected  by  any  bright  light,  whether 
natural  or  artificial.  Some  even  are  unable  to  bear  any  light  more 
brilliant  than  twilight.  Notwithstanding  the  use  of  colored  glasses, 
shades,  &c.,  they  are  obliged  to  avoid  mid-day  ;  and  sometimes  even 
to  deprive  themselves  of  artificial  light.  The  retina  will  not  even 
bear  the  light  of  a  bright  fire.  This  photophobia  probably  arises 
from  the  increased  dilatation  of  the  pupil,  observable  in  most  of 
these  patients.  Dilatation  of  the  pupil  is  an  important  symptom  in 
such  cases,  because  it  affords  a  means  of  diagnosis  between  this  kind 
of  photophobia,  and  that  which  arises  from  irritation  of  the  retina — 
irritation  always  causing  extreme  contraction  of  the  pupillary  opening. 


284  SYMPTOMS    OF    SPERMATOEEHCBA. 

To  conclude,  then.  Among  the  changes  observed  in  the  organs 
of  vision,  those  that  are  attributable  to  masturbation,  venereal  ex- 
cesses, or  involuntary  seminal  discharges,  consist  in  a  diminished 
activity,  with  disorder  of  the  functions,  defective  harmony  of  ac- 
tion, &c.  Sometimes  weakness  predominates,  sometimes  disorder, 
according  to  the  temperament  or  idiosyncrasy  of  the  patient ;  but 
their  co-existence  is  not  always  easily  made  out.  Both  depend  on 
the  nervous  system. 

ENCEPHALON. 

Sleep  and  Waking. — The  opposite  conditions  of  sleep  and  waking 
are  marked  in  proportion  as  the  health  is  perfect.  Sleep  is  long 
and  sound,  after  active  and  continued  exercise.  Hence  the  robust 
individual,  who  undergoes  great  fatigue,  rests  long  and  well.  The 
first  effect  of  prolonged  inaction  is  to  render  the  sleep  lighter  and 
less  long.  Whilst,  on  the  other  hand,  broken  and  disturbed  sleep 
disinclines  the  person  to  activity  on  the  following  day. 

This  effect  is  very  remarkable  in  persons  debilitated  by  masturba- 
tion, venereal  excesses,  or  involuntary  seminal  discharges.  They 
sleep  little  and  badly  during  the  night,  and  habitually  pass  the  day 
in  a  state  of  somnolence  and  torpor.  There  is  good  reason  to  sus- 
pect abuse  in  a  child  who  remains  motionless  in  a  corner  whilst  his 
companions  enjoy  their  noisy  sports  ;  who  sighs  over  his  lessons  and 
sleeps  over  his  books.  This  sign  is  a  strong  one,  and  easily  disco- 
verable ;  sleep  during  the  night  may  be  easily  stimulated.  I  have 
recently  seen  a  child  of  seven  years  of  age,  who  practised  masturba- 
tion and  passed  five  months  without  sleeping  during  the  night,  with- 
out being  discovered.  Venereal  excesses  produce  the  same  results, 
but  in  this  case  the  truth  is  easily  ascertained. 

The  sleep  of  patients  suffering  from  spermatorrhoea  is  generally 
light,  broken,  and  unrefreshing.  They  get  up  more  fatigued  than 
they  went  to  bed.  Hence,  they  go  to  bed  late  and  get  up  with  un- 
willingness, even  when  they  are  unable  to  obtain  sleep  in  the  morn- 
ing. Their  sleep  is  unrefreshing  because  it  is  continually  broken 
by  nightmare  and  frightful  dreams,  which  increase  as  the  disease  ad- 
vances. Painful  sensations  arise  in  the  stomach,  and  intestines, 
liver,  kidneys,  or  bladder,  the  functions  of  which  are  deranged  ;  pal- 
pitations and  sense  of  suffocation  are  felt — the  functional  disorder  of 
the  respiratory  and  circulating  systems  coming  on  as  during  waking. 

At  a  still  more  advanced  period  of  the  disease,  sleep  leaves  the 
patient  entirely.  They  often  pass  a  whole  night  in  agitation  without 
being  able  to  find  a  comfortable  posture  ;  they  get  up  and  lie  down 
again,  walk  about,  or  roll  on  their  beds  ;  at  one  moment  their  bodies 
and  temples  are  on  fire,  at  the  next  they  are  chilly,  and  covered  with 
cold  sweat.  During  these  long  nights  they  constantly  dwell  on  sad 
thoughts,  and  are  especially  tempted  to  commit  suicide.  Such  dis- 
turbed nights  must  produce  the  worst  consequences  on  the  cerebral 
functions,  for  sleep  alone  could  put  an  end  to  the  nervous  debility 


GENEEAL    SYMPTOMS.  285 

and  restore  its  activity  to  the  brain.  Hence  the  loss  of  sleep  is  the 
chief  cause  of  the  torpor  and  somnolency  observable  in  these  patients 
during  the  day. 

Clieplialalgia. — Patients  suffering  from  involuntary  seminal  dis- 
charges generally  experience  heaviness  in  the  head  and  sense  of 
compression  of  the  brain,  as  if  the  organ  were  swollen  ;  others,  on 
the  other  hand,  complain  of  a  feeling  of  void  in  the  head.  To  these 
sensations  dull  pains  succeed,  and  these  are  seldom  fixed. 

Such  symptoms  are  often  attributed  to  accidental  causes,  the 
patients  being  for  the  most  part  unconscious  of  their  true  origin. 
Some  patients,  too,  suffer  from  fixed  and  almost  continual  pain  in  a 
certain  spot.  I  have  generally  found  that  the  supra-orbital  region 
is  complained  of  in  these  cases.  As  the  disease  progresses,  these 
symptoms  become  more  severe,  and  are  conjoined  with  vertigo,  noise 
in  the  ears,  flushing,  heat  of  the  head,  disorder  in  the  ideas,  stam- 
mering, &c.,  and  hence  very  often  structural  disease  of  the  brain  is 
suspected,  especially  if  the  cephalalgia  comes  on  habitually  in  the 
same  region.  I  have  met  with  many  cases  in  which  this  happened, 
and  which  had  been  treated  for  years  by  distinguished  practitioners 
without  benefit. 

Cranial  Congestion. — Although  patients  suffering  from  sperma- 
torrhoea are  generally  pale,  they  are  exposed  to  attacks  of  cerebral 
congestion,  generally  slight  and  of  short  duration,  but  sometimes 
very  alarming.  At  first  these  attacks  are  limited  to  flushed  face, 
brought  on  by  constipation,  difficult  digestion,  the  collection  of  flatus 
in  the  intestinal  canal,  &c.,  at  other  times,  by  the  heat  of  a  room, 
acute  emotion,  sudden  disorder  of  the  circulation,  or  momentary 
difficulty  of  breathing.  When  the  health  is  deranged,  constipation 
considerably  increases  the  flow  of  blood  to  the  head,  and  constipation 
is  one  of  the  most  common  symptoms  of  the  disorder  of  which  I  am 
treating.  Apparently  trifling  causes  produce  serious  effects  in  these 
cases,  owing  to  the  increased  weakness  and  susceptibility  of  the 
organs.  In  the  latter  stages  of  the  disease,  the  congestion  may  be 
carried  so  far  that  the  whole  head  appears  swollen,  of  a  dark  red 
color  and  burning  heat. 

Such  attacks  of  congestion  are  not  confined  to  the  skin  ;  every 
thing  concurs  to  show  that  the  same  phenomena  take  place  in  the 
very  substance  of  the  brain.  There  are  present  at  the  same  time, 
vertigo,  dazzling  of  sight,  noise  in  the  ears,  and  a  sense  of  internal 
pulsation  with  great  anxiety,  agitation,  and  uneasiness,  and,  in  some 
cases,  the  intellectual  faculties  are  deranged.  When  the  congestion 
is  severe,  the  patients  do  not  recognize  arwr  one;  they  know  not 
where  they  are  or  what  they  do  ;  but  they  want  to  change  their  pos- 
ture, to  breathe  the  fresh  air,  and  especially  to  walk,  although  their 
legs  can  scarcely  support  them,  and  if  not  closely  watched  they  are 
liable  to  fall.  In  a  few  cases  the  patients  became  quite  insensible, 
and  fall  into  a  condition  exactly  resembling  apoplexy. 

The  medical  man,  called  during  one  of  these  alarming  attacks,  is 
at  first  struck  with  congestion  of  the  face  and  the  increased  rapidity 


286  SYMPTOMS    OF    SPEEMATORRHCEA, 

of  the  pulse.  He  is  told  of  frequent  giddiness  experienced  by  the 
patients,  of  embarrassed  speech,  and  momentary  stuttering,  of  weak- 
ness of  the  limbs,  and  even  of  frequent  falls,  of  constant  headache, 
&c.  He  naturally,  therefore,  concludes  that  the  case  before  him  is 
one  presenting  imminent  danger  of  apoplexy. 

During  these  attacks,  the  brain  is  indeed  the  seat  of  congestion, 
as  well  as  the  face,  and  the  medical  man  called  is  not  deceived  on 
this  point.  His  error  consists  in  not  recognizing  the  cause  of  the 
congestion,  in  not  foreseeing  its  short  duration,  in  exaggerating  its 
consequences,  and  especially  in  treating  it  by  the  most  fatal  means. 
In  fact,  these  attacks  of  congestion  are  brought  on  by  the  debilitat- 
ing discharges  ;  they  are  alarming  in  proportion  to  the  patient's 
weakness  ;  they  never  terminate  in  cerebral  hemorrhage  ;  and  no 
treatment  can  be  worse  than  abstraction  of  blood. 

It  seems  astonishing  that  debility,  should  produce  congestions, 
which  are  generally  looked  on  as  the  results  of  plethora  ;  but  on 
careful  examination  it  will  be  seen  that  important  points  of  difference 
exist  between  them.  Besides  this,  it  is  by  no  means  remarkable  to 
see  similar  phenomena  produced  by  opposite  causes. 

It  often  happens  in  the  commencement  of  cerebral  affections,  that 
a  copious  abstraction  of  blood  is  followed  by  sudden  congestion  of 
the  head  with  convulsions.  No  one  doubts  that  plethora  frequently 
produces  palpitation  of  the  heart,  sense  of  suff'ocation,  &c.,  yet  we 
have  just  seen  that  the  same  results  may  be  caused  by  an  opposite 
state.  The  same  remarks  apply  to  the  dizziness,  noise  in  the  ears, 
partial  and  momentary  paralysis  of  the  retina,  photophobia,  &c. 

These  attacks  of  congestion  become  more  frequent  in  proportion 
as  the  weakness  progresses,  but  they  are  generally  of  short  duration, 
because  they  depend  rather  on  the  irritability  of  the  circulating  sys- 
tem, than  on  a  too  great  impulse  given  to  the  blood,  or  over-fulness 
of  the  vessels.  There  is  not,  therefore,  the  same  danger  of  capillary 
hemorrhage  as  in  ordinary  congestion,  and  still  less  of  any  consider- 
able eff*asion  taking  place. 

An  attack  of  apoplexy  may  cause  death  in  a  plethoric  individual 
without  producing  effusion,  the  vessels  of  the  brain  being  sufficiently 
distended  to  hinder  the  functions  of  the  organ.  When  hypertrophy 
of  the  heart  is  not  brought  on  by  some  obstruction  to  the  circula- 
tion situated  near  the^commenceraent  of  the  aorta,  the  impulse  of 
the  blood  may  be  sufficiently  violent  to  cause  extravasation  in  the 
extreme  vessels  ;  and  when  the  latter  are  diseased,  a  less  powerful 
impulse  may  cause  a  rupture  in  any  point  of  their  coats,  followed  by 
a  considerable  clot.  Nothing  of  this  kind  exists  in  persons  suffering 
from  spermatorrhoea,  and  hence  congestion  does  not  produce  any  of 
these  effects,  although  the  attacks  may  take  place  frequently,  and 
become  more  alarming  in  proportion  as  the  disease  advances.  When 
the  patients  die,  it  is  rather  in  consequence  of  a  slow  wearing  out 
than  from  the  immediate  attack ;  they  generally  expire  in  a  kind  of 
syncope,  after  all  the  congestive  phenomena  have  passed  off — not 
the  least  trace  of  them  being  found  in  the  brain  or  its  membranes. 


I 


GENERAL    SYMPTOMS.  287 

It  is  evident  that  these  attacks  differ  greatly  in  their  indications 
from  other  congestions  of  the  brain.  Abstraction  of  blood  may 
prove  fatal,  and,  unfortunately,  this  is  the  first  idea  that  presents 
itself.  The  practitioner  called  for  the  first  time  to  a  patient  with 
such  an  attack,  must  take  into  consideration  the  general  appear- 
ance of  the  system,  the  state  of  the  strength,  the  embonpoint,  and 
especially  the  condition  of  the  circulation.  The  pulse  is  generally 
hurried  and  irregular,  but  never  full,  distended,  or  resistant.  Slight 
pressure  on  the  artery  arrests  the  pulsation  altogether  ;  indeed,  it 
can  hardly  be  felt,  unless  the  finger  barely  touches  the  skin.  With 
such  a  pulse  there  can  be  no  danger  of  cerebral  hemorrhage,  and 
the  abstraction  of  blood  would  be  extremely  injurious  if  not  fatal. 
The  pulse,  therefore,  is  the  chief  guide  in  such  cases. 

Alteration  of  Character. — In  general,  the  moral  susceptibility  in- 
creases with  the  progress  of  physical  weakness.  But  those  patients 
who  are  naturally  hasty,  become  the  most -impatient  and  irritable. 
They  are  restless,  exacting,  unjust ;  trifling  circumstances  sour  and 
irritate  them,  drawing  from  them  complaints  and  reproaches.  The 
least  delay  in  complying  with  their  demands,  or  a  slight  awkward- 
ness in  waiting  upon  them,  throws  them  into  a  fury. 

I  have  seen  such  patients  sometimes  roll  themselves  on  the  earth 
in  furious  and  prolonged  agitation,  when  unable  to  obtain  what 
they  desired.  These  violent  scenes  of  nervous  excitement  happen 
especially  after  abundant  or  frequent  pollutions.  As  soon  as  con- 
valescence commences,  a  rapid  change  takes  place.  The  predomi- 
nance of  such  symptoms  undoubtedly  arises  in  a  considerable  degree 
from  the  patient's  natural  impatience  ;  but  they  increase  or  diminish 
in  a  remarkable  manner,  according  to  their  strength  ;  that  is  to  say, 
according  to  the  frequency  of  the  involuntary  discharges.  When 
spermatorrhoea  commences  after  marriage  it  produces  an  unexpected 
change  in  the  character  of  the  husband,  which  contributes  even 
more  than  impotence  to  domestic  unhappiness.  Frequent  marks  of 
ill  humor,  bitter  words,  and  violent  discussions,  soon  succeed  indiffer- 
ence— contrasting  strongly  with  the  conduct  before  the  commence- 
ment of  the  disease,  and  consequently  producing  a  highly  unfavor- 
able impression. 

Most  of  these  patients,  too,  experience  a  profound  sense  of  lan- 
guor, discouragement,  and  melancholy,  giving  a  peculiar  stamp  to 
their  character,  with  which  all  observers  have  been  struck.  The 
commonness  of  these  symptoms,  the  importance  that  has  always  been 
attached  to  them,  and  the  discussions  to  which  they  have  given  rise, 
require  special  attention  ;  otherwise  they  ought  not  to  be  considered 
separately  from  the  other  functional  disorders  of  which  I  have 
already  treated.  But  they  have  always  been  considered  as  a  spe- 
cial malady,  or  idiopathic  affection:  I  mean  hypochondriasis. 

Hypochondriasis. — The  patients  of  whom  I  am  at  present  speaking 
are  continually  beset  by  bitter  regrets,  sombre  thoughts  and  horrible 
presentiments.     They  feel  a  void  in  all  their  affections  ;  nothing  in- 


288  SYMPTOMS    OF    SPEEMATOEEHCEA. 

terests  them  ;  everything  fatigues  and  annoys  them  ;  existence  weighs 
them  down  without  any  other  apparent  cause  than  a  deep  disgust 
for  everything  which  can  make  life  pleasant.  This  vague  and  in- 
stinctive feeling,  this  tsedium  vitse,  which  they  are  not  able  to  explain 
to  themselves,  follows  them  everywhere  and  constantly  tempts  them 
to  commit  suicide.  Nevertheless  these  same  persons  are  most  occu- 
pied about  their  health,  and  dread  the  greatest  misfortunes.  I  need 
not  reconsider  the  minute  care  they  bestow  on  their  digestion,  the 
state  of  their  bowels,  &c.,  and  I  shall  only  add  a  few  words  to  what 
I  have  already  said  concerning  their  varied  and  continued  fears. 

During  the  night  they  fancy  they  see  thieves  and  murderers  every 
where ;  when  travelling  they  fear  being  upset,  falling  down  precipices, 
being  drowned,  &c.  ;  those  who  are  in  business  fancy  themselves 
ruined,  or  on  the  point  of  being  so — the  clearest  and  most  rigorous 
calculations  failing  to  reassure  them — at  all  events  their  fears  soon 
return,  even  if  once  convinced.  Land  proprietors,  whose  immense 
incomes  are  imperishable,  are  nevertheless  haunted  by  the  fear  of 
dying  of  hunger.  It  seems  at  first  difficult  to  reconcile  such  constant 
cares  for  self-preservation,  with  disgust  of  life,  and  inclination  to 
suicide.  This  contradiction  would  in  fact  be  inexplicable  if  jt  arose 
from  reason  or  will.  But  the  two  contrary  impulses  which  govern 
these  patients  are  equally  instinctive,  and  depend  on  the  same  dis- 
ease. They  are  not  opposed  in  reality,  for  the  derangement  of  all 
the  functions,  and  the  cares,  wants,  and  constant  apprehensions 
arising  from  it,  contribute  greatly  to  the  dislike  of  life  and  to  the  de- 
sire to  put  an  end  to  such  great  physical  and  moral  suiferings. 

It  is  evident  that  these  impulses  are  independent  of  reason,  be- 
cause they  reappear  with  equal  force,  whenever  the  patients  experi- 
ence a  relapse,  although  they  may  know  perfectly  well  that  their 
former  fears  were  ill-founded,  and  their  disgust  of  life  arose  entirely 
from  the  presence  of  involuntary  seminal  discharges.  They  admit 
even  that  it  is  natural  to  attribute  the  reappearance  of  such  ideas 
to  the  return  of  their  former  complaint,  but  at  the  same  time  they 
believe  themselves  threatened  by  other  dangers  and  under  more 
unfavorable  circumstances  ;  and  above  all  things  they  regard  their 
disorder  as  incurable,  because  it  has  returned.  In  a  word,  past 
experience  fails  to  convince  them,  if  ever  they  fall  a  second  time 
under  the  influence  of  the  disease. 

I  have  seen  such  relapses  last  only  a  few  days,  and  take  place  for 
the  fortieth  or  fiftieth  time,  and  nevertheless  the  same  sadness,  dis- 
couragement and  despair,  have  returned  on  each  occasion.  Some- 
times two  or  three  nocturnal  pollutions  occurring  in  a  short  space  of 
time  suffice  to  work  a  complete  change  in  the  character  of  the  patient. 
But,  on  the  other  hand,  spermatorrhoea  never  pursues  a  uniform  and 
continuous  course.  The  discharges  diminish,  or  cease  entirely  for  a 
short  time,  without  the  patient  being  able  to  explain  the  cause  of  such 
variations.  During  these  intermissions  a  rapid  improvement  takes 
place  in  all  the  functions — especially  in  the  digestion  ;  a  general 


GENERAL    SYMPTOMS.  289 

feeling  of  comfort  and  vigor  is  experienced.  Tiie  patients  believe 
themselves  cured,  or  on  the  point  of  being  so,  and  the  joy  they  ex- 
perience is  manifested  vi'ith  extreme  vivacity,  in  proportion  as  their 
temperaments  are  lively. 

The  next  day  these  appearances  of  happiness  may  again  give  way 
to  melancholy  and  despair  without  the  possibility  of  any  person's 
divining  the  cause  of  so  sudden  and  complete  a  change — effects 
which  are  mostly  produced  by  the  occurrence  of  diurnal  pollutions 
— generally  unperceived  by  the  patients. 

As  the  disease  makes  progress,  the  periods  of  remission  become 
rarer  and  shorter ;  still  there  are  always  times  when  the  patients 
are  better,  and  times  when  they  are  much  worse,  following  the  acci- 
dental diminution  and  increase  of  the  involuntary  discharges.  Hence 
the  inequality  of  temper,  the  strange  changes  of  determination,  the 
variability  of  inclinations,  conduct,  and  affections,  which  make  the 
characters  of  these  patients  an  incomprehensible  enigma. 

By  recollecting  what  I  have  already  stated  respecting  the  constant 
and  minute  attention  such  patients  are  obliged  to  pay  to  their  food, 
drink,  clothing,  &c.,  to  the  state  of  their  digestion,  their  alvine  dis- 
charges, and  their  urine;  to  all  the  changes  of  temperature,  moisture, 
and  electricity  ;  by  taking  into  consideration  all  the  symptoms  that 
are  referred  to  the  liver,  the  intestines,  the  stomach,  the  spleen;  the 
annoyance  of  flatus ;  the  palpitations  and  oppression  of  the  chest;  it 
will  become  evident  that  the  reunion  of  all  these  symptoms  constitutes 
the  most  perfect  description  of  what  is  called  hypochondriasis. 

3Iemo7'y. — Patients  suffering  from  spermatorrhoea,  like  old  people, 
by  degrees  lose  their  memory  for  facts,  dates,  numbers  and  even 
words  ;  and  this  greatly  increases  their  repugnance  to  conversation. 
After  beginning  a  sentence  they  often  forget  what  they  wished  to  say, 
or  are  unable  to  find  the  particular  expression  they  desire  ;  they 
become  nervous  and  begin  to  stutter,  as  if  the  articulation  of  sounds 
were  difficult.  This  difficulty  of  articulation,  however,  really  does 
exist  in  the  advanced  stages  of  the  complaint;  the  tongue  then  shar- 
ing in  the  disorder  of  the  other  parts  of  the  muscular  system,  and 
the  irregularity  of  its  motions  being  increased  by  the  want  of  preci- 
sion in  the  ideas. 

These  patients  also  forget  their  promises,  arrangements,  and  en- 
gagements, in  fact  everything  which  ought  to  be  of  chief  interest 
to  them,  just  like  individuals  in  a  state  of  deraency. 

This  forgetfulness,  however,  does  not  exclusively  arise  from  loss 
of  memory  ;  the  carelessness  of  the  patients,  and  their  constant  pre- 
occupations, are  an  important  cause  of  it.  The  concentration  of 
'their  thoughts  on  their  health  renders  them  indifferent  to  other 
things,  and  when  they  neglect  the  most  important  matters,  it  is  fre- 
quently because  they  do  not  feel  interested ;  for  the  same  reason, 
too,  they  do  not  understand  what  is  said  to  them,  and  do  not  con- 
sider their  actions.  It  seldom  happens,  then,  that  loss  of  memory 
is  the  only  cause  of  all  the  irregularities  these  patients  commit. 


290  SYMPTOMS    OF    SPERMATORRHOEA. 

Masturbation,  even  before  puberty,  produces  exactly  the  same 
eifects  as  spermatorrhcea ;  the  same  forgetfulness  and  neglect  result 
from  it,  and  there  is  especially  great  difficulty  in  retaining  even  the 
most  simple  lessons,  notwithstanding  the  power  of  the  memory  for 
words  at  that  age. 

Intellect. — The  intellectual  faculties  differ  greatly  in  different  in- 
dividuals not  only  from  difference  of  education,  but  also  from  pri- 
mary development.  The  results  of  spermatorrhoea  therefore  vary 
with  these  varying  conditions  ;  generally  speaking,  congenital  defi- 
ciencies chiefly  appear.  In  all  classes  of  society  there  are,  naturally, 
powerful  intellects  like  strong  constitutions  ;  such  advantages, 
whether  they  receive  all  the  development  of  which  the  individuals 
are  susceptible  or  not,  are  maintained  better  under  all  circumstances 
than  those  which  have  been  acquired  by  education  and  exercise. 

Age  also  must  be  taken  into  consideration.  The  effects  of  invol- 
untary  seminal  discharges  are  the  more  injurious  in  proportion  as 
the  patients  are  further  removed  from'  that  period  of  strength  and 
energ}'  during  which  the  constitution  possesses  all  its  natural  vigor. 
Hence  it  arises  that  the  most  rapid  and  serious  intellectual  changes 
take  place  at  the  beginning  and  towards  the  close  of  life.  I  have 
seen  children,  previously  very  intelligent,  almost  suddenly  fall  into 
a  state  of  idiocy,  the  cause  of  which  was  little  suspected  on  account 
of  their  early  age,  the  other  functions  not  suffering  proportionately. 
When  a  child,  after  having  afforded  evidence  of  strong  intellect  and 
memory,  experiences  from  day  to  day  more  difficulty  in  retaining 
what  he  is  taught,  we  may  rest  assured  that  this  does  not  arise  from 
indisposition  or  from  idleness,  as  is  often  supposed.  On  the  other 
hand,  the  slow  but  progressive  derangement  of  his  health,  his  con- 
stantly increasing  loss  of  activity  and  application,  arise  from  the 
same  cause.  The  intellectual  faculties  are  simply  the  first  to  feel 
disorder,  and  show  it  more  than  the  others. 

Of  course  I  do  not  here  refer  to  idle  or  dull  children,  who  have 
never  been  able  to  keep  pace  with  their  companions  ;  I  speak  of 
such  as  show  at  first  the  most  happy  qualities,  after  a  time  relax 
their  endeavors  more  and  more  without  evident  cause,  and  over- 
throw the  hopes  of  their  instructors.  In  such  cases,  diminished 
aptness  for  learning  ought  to  be  held  quite  sufficient  evidence  to  in- 
duce inquiry  and  careful  watching. 

At  a  later  period  venereal  excesses  may  suddenly  cut  short,  in  a 
brilliant  career,  those  who  have  escaped  the  dangers  of  masturbation. 
All  such  unexpected  reverses  are  easily  explained  by  those  who  are 
aware  of  the  influence  of  the  genital  system  over  the  intellectual 
faculties.  Correct  information  Avould  clearly  show  why  some  chil- 
dren cease  to  carry  off  the  prizes  of  their  class ;  and  why  at  a  later 
period,  some  young  men  fail  in  studying  the  law,  medicine,  or  the 
sciences,  after  having  successfully  commenced  such  studies. 

Nevertheless  these  first  failures  would  be  only  momentary  if  they 
were  not  afterwards  kept  up  by  the  occurrence  of  involuntary  dis- 
charges ;    most   of  the  patients   succeed  in   correcting  themselves, 


GENERAL    SYMPTOMS.  291 

although  perhaps  only  when  they  are  no  longer  ahle  to  continue  their 
habits  ;  after  which  they  are  almost  invariably  ignorant  of  the  cause 
that  prevents  the  return  of  their  former  intellectual  energy.  On  the 
other  hand,  again,  involuntary  seminal  discharges  do  not  always  arise 
from  masturbation  or  venereal  excesses  ;  they  require  particular  at- 
tion  therefore  on  all  accounts. 

I  have  already  spoken  of  congenital  weakness  of  the  genital  organs, 
and  the  disposition  to  involuntary  discharges  arising  therefrom  ;  I 
have  mentioned,  too,  that  intellectual  excitement  of  all  kinds,  when 
carried  too  far,  irritates  and  weakens  such  organs.  Hence  it  is  clear 
that  literary  men,  artists,  savans,  &c.,  by  giving  themselves  up  too 
ardently  to  the  study  which  interests  them,  are  exposed  to  involun- 
tary discharges,  however  little  they  may  be  liable  to  them  from  other 
causes.  Active  cerebral  excitement  at  first  produces  increased  ac- 
tivity in  the  sexual  organs,  especially  if  a  sitting  position  be  long 
maintained — a  slight  increase  of  virility  resulting.  Long  continued 
application,  however,  added  to  want  of  exercise,  &c.,  weakens  all 
the  functions,  commencing  with  the  least  energetic.  The  erections 
diminish  and  disappear,  which  seems  natural  enough  when  the  ab- 
sorption of  the  thoughts  is  taken  into  consideration  ;  but  after  a  short 
time  mental  application  becomes  less  easy  and  more  fatiguing,  and 
its  results  are  not  so  satisfactory. 

In  this  condition  exercise  and  relaxation  may  re-establish  the  cere- 
bral functions  ;  but  after  a  time  these  means  only  produce  slight 
improvement.  All  those  notions  of  advancement,  which  had  sus- 
tained the  powers  under  intense  study,  must  be  abandoned,  and  give 
place  to  the  constant  care  of  health,  which  deteriorates  daily. 

What  has  taken  place  in  these  cases?  Involuntary  discharges  are 
established,  or  have  notably  increased  in  frequency.  These  dis- 
charges keep  up  the  weakness  of  the  previously  over-worked  brain, 
and  oppose  the  re-establishment  of  its  functions,  notwithstanding  the 
most  constant  hygienic  care.  Such  patients  are  generally  in  the  prime 
of  life,  and  completely  absorbed  b}^  their  studies,  when  they  first  feel 
their  intellectual  powers  rapidly  decline.  The  absence  of  all  appa- 
rent symptoms  on  the  part  of  the  genital  organs  prevents  the  patients 
from  there  seeking-  the  cause  of  the  disorder :  they  only  regard  it  as 
the  effect  of  an  overworked  nervous  system,  which,  in  a  few  in- 
stances, is  actually  the  case.  Under  these  circumstances,  however, 
a  short  respite  from  study,  combined  with  exercise,  restores  the  pa- 
tient for  a  time ;  but  he  relapses  after  further  application,  and  these 
means  are  of  no  service ;  involuntary  discharges  are  now  established, 
and  alone  oppose  the  patient's  recovery.  The  nocturnal  pollutions 
diminish,  but  the  symptoms  increase — diurnal  ones  have  commenced, 
and  become  daily  more  frequent,  and  consequentl}?  more  injurious. 

Insanity/. — Many  patients  had  been  treated  in  lunatic  asylums 
before  they  came  under  my  care.  In  these  cases  the  disorder  of  the 
intellectual,  moral,  and  affective  faculties  varied  from  severe  hypo- 
chondriasis to  violent  mania.     Strange  hallucinations,  together  with 


292  SYMPTOMS    OF    SPEEMATOEEH(EA. 

inclination  to  suicide,  temptation  to  commit  murder,  and  violent  fits  of 
rage,  were  common.  For  these  reasons  the  patients  had  been  placed 
in  asylums,  and  treated  like  ordinary  madnfien;.  but  in  all  the  cases 
that  have  come  under  my  notice,  the  mental  derangement  followed 
the  variations  of  the  involuntary  seminal  discharges  in  all  respects. 

Mania,  however,  is  the  least  common  of  all  disorders  of  the  brain, 
produced  by  spermatorrhoea.  The  chronic  form  of  derangement  is 
much  more  frequent.  This  disorder  corresponds  in  a  remarkable 
manner  with  that  described  by  Pinel  as  melancliolia  ;  by  Dr.  Rush  as 
tristimania  or  hi/pochondriasis,  and  by  Esquirol  as  lyijomania.  In  all 
cases  of  this  disorder  the  distinctive  characters  are — an  irresistible 
sadness,  melancholy  and  depression  of  spirits,  fondness  for  silence 
and  solitude,  with  thoughts  constantly  engaged  in  imagining  dreadful 
events  about  to  happen  ;  universal  distrust,  often  carried  as  far  as  the 
most  savage  misanthropy ;  extreme  timidity  of  character  ;  a  series  of 
hallucinations,  generally  bearing  on  plots  against  life  or  imaginary 
persecutions  ;  and  lastly,  above  all,  a  profound  disgust  of  life  ;  and, 
in  consequence,  an  instinctive  and  continual  impulse  to  suicide. 

Such  are  the  symptoms  given  by  all  authors  as  characterizing  this 
particular  class  of  mental  diseases.  I  need  scarcely  remark  that  they 
coincide  exactly  with  those  of  patients  suffering  from  spermatorrhoea. 
We  must  therefore  admit,  that  spermatorrhoea  remarkably  favors 
the  development  of  lypomania.  I  confine  myself  to  asserting  that 
the  development  of  lypomania  is  favored  by  spermatorrhoea,  because 
it  is  necessary  to  admit  that  a  primary  disposition  to  cerebral  dis- 
order must  be  present  in  these  cases.  Without  this  we  should  not 
be  able  to  explain  why,  in  certain  cases  the  patients  escape  all  dis- 
order-of  the  cerebral  functions;  why,  in  other  cases,  these  disorders 
present  infinite  varieties  of  degree  ;  and  why  the  same  symptoms 
come  on  under  other  circumstances.  We  must,  therefore,  only  de- 
fine spermatorrhoea  to  be  a  determining  cause  of  lypomania. 

The  influence  of  involuntary  discharges  is,  however,  so  powerful 
and  direct,  that  reason  is  soon  re-established  as  soon  as  they  are  ar- 
rested ;  whilst  other  modes  of  treatment  are  of  little  or  no  efficacy. 

Pinel  and  Esquirol  remarked  the  influence  of  masturbation  and 
venereal  excesses  in  causing  melancholia  or  lypomania.  Dr.  Des- 
landes  extends  his  observations  to  all  kinds  of  mental  derangement ; 
and,  among  other  facts,  he  calls  to  the  support  of  his  arguments  the 
statistics  of  asylums  for  the  insane.  Out  of  256  individuals  admitted 
into  the  asylum  of  Cbarenton,  during  the  years  1826,  '27,  '28,  there 
were  44  men  whose  insanity  was  attributable  to  masturbation  or 
venereal  excesses  ;  whilst  only  three  women  owed  their  derangement 
to  similar  causes.  Dr.  Hoist,  too,  has  given  similar  information,  de- 
rived from  the  insane  in  the  kingdom  of  iNlorway.  Dr.  Deslandes, 
however,  remarks  that  this  cannot  be  regarded  as  an  exact  relative 
proportion,  on  account  of  the  objections  women  would  have  to  aff'ord- 
ing  such  information.  Esquirol  thinks,  too,  that  masturbation  is 
more  frequently  concealed  among  females  than  among  males. 


GENERAL    SYMPTOMS.  293 

Although  the  observers,  of  whom  I  have  just  spoken,  have  men- 
tioned the  influence  of  abuses  or  excesses  in  causing  insanity,  they 
have  completely  mistaken  the  cause  which  afterwards  keeps  up  the 
mental  disorder.  In  asylums  venereal  excesses  cannot  continue,  and 
sure  means  of  preventing  masturbation  are  at  hand  ;  it  even  happens 
most  frequently  that  both  have  ceased  a  long  time  without  the  least 
improvement  in  the  symptoms  being  observed,  because  they  are  kept 
up  by  diurnal  pollutions,  as  I  have  already  shown.  None  of  the 
authors  referred  to  have,  however,  mentioned  these  ;  indeed  they 
are  not  even  hinted  at  in  any  work  on  insanity. 

It  is  perhaps  to  the  presence  of  such  pollutions  that  we  must 
attribute  the  relative  paucity  of  cures  in  the  male — for  all  who  have 
made  statistical  researches  on  insanity,  assert  that  in  all  countries, 
and  under  all  kinds  of  treatment,  there  are  fewer  recoveries  among 
men  than  among  women. 

But  all  mental  affections  do  not  consist  of  disorde?'  of  the  intel- 
lectual, moral,  or  affective  faculties  ;  there  maybe  also  debility,  and 
this  may  be  the  predominating  phenomenon,  or  may  exist  alone. 
Dementia  is  the  worst  degree  of  this  affection,  just  as  mania  is  the 
most  severe  degree  of  insanity.  Incurable  cases  of  vesania  termi- 
nate in  dementia  ;  but  it  has  long  been  known  that  dementia  is  not 
always  preceded  by  mania  or  delirium,  and  that  it  may  even  reach 
the  last  degree  of  severity  without  being  complicated  with  any  dis- 
order of  the  kind.  Such  cases,  then,  only  differ  from  senile  dementia 
by  the  youth  of  the  patients  ;  and  this  early  debility  may  make 
rapid  progress,  constituting  acute  dementia. 

On  comparing  the  descriptions  which  have  been  given  of  the  dif- 
ferent kinds  of  dementia  with  the  symptoms  of  patients  suffering 
from  spermatorrhoea,  it  is  impossible  not  to  be  struck  with  their 
similarity.  What  is  called  simple  dementia  really  presents  no  diffe- 
rence from  what  is  observed  in  the  last  stages  of  spermatorrhoea. 
In  both  cases  there  is  invariably  a  progressive  loss  of  the  memory 
of  facts,  dates,  words,  &c.,  with  loss  of  imagination,  power,  intellect, 
and  determination. 

We  have  just  seen  that  many  observers  have  admitted  the  influence 
of  masturbation  and  venereal  excesses  in  the  production  of  mania  and 
lypomania.  Dr.  Deslandes  believes  that  these  causes  also  frequently 
bring  on  dementia.  I  am  strongly  of  his  opinion,  because  the  loss 
of  their  reason  removes  from  the  insane  as  well  as  from  the  idiot  the 
strongest  check  the  passions  possess.  Esquirol  very  judiciously  ob- 
serves, that  masturbation  is  the  greatest  obstacle  to  the  cure  of  the 
insane  on  account  of  the  stupid,  brutish  condition  into  which  the 
habit  throws  them.  From  this  it  is  evident  that  diurnal  pollutions 
must  still  more  favor  and  hasten  dementia,  because  they  act  much 
more  energetically  and  without  encountering  any  check.  Persons 
addicted  to  masturbation  are  watched  and  mechanically  guarded  ;  but 
diurnal  pollutions  are  not  even  suspected,  much  less  guarded  against. 
They  are,  on  the  contrary,  favored  by  certain  circumstances  affect- 
19 


294  SYMPTOMS    OF    SPEEMATORRHCEA. 

ing  the  insane.  Sexual  intercourse  is  denied  them ;  they  are  con- 
demned to  inaction,  or,  at  all  events,  are  unable  to  obtain  regular 
and  active  exercise  ;  they  frequently  suffer  from  prolonged  consti- 
pation, &c.  These  causes  are  sufficient  to  bring  on  involuntary  dis- 
charges even  in  cases  where  there  had  been  no  previous  bad  habits, 
or  venereal  excesses  ;  still  more,  then,  must  they  increase  sperma- 
torrhoea, when  once  set  up  by  previous  irregularities. 

These  reasons  lead  me  to  conclude  that  dementia  is  frequently 
caused  by  diurnal  pollutions;  and  this  conclusion  seems  more  strongly 
confirmed  by  the  debility  of  the  muscular  system;  for  dementia 
bears  the  same  relation  to  paralysis  that  delirium  does  to  epilepsy. 

General  and  Incomjylete  Paralysis  of  the  Insane. — This  generally 
accompanies  and  follows  the  same  course  as  dementia  ;  both  are  phe- 
nomena of  the  same  nature,  and  both  arise  from  weakness  of  the 
cerebral  organs.  General  and  incomplete  paralysis,  first  noticed  by 
Pinel,  and  studied  with  much  attention  by  Esquirol,  has  since  been 
the  object  of  special  research  by  MM.  Delaye,  Bayle,  Calmiel,  and 
Foville.  The  descriptions  of  all  these  authors  agree  remarkably 
with  the  symptoms  observed  in  the  last  stage  of  spermatorrhoea. 

At  first  there  is  only  observed  slight  embarrassment  of  the  tongue, 
with  stiffness  in  all  the  emotions — a  general  awkwardness  attended 
with  more  or  less  trembling.  After  a  time  certain  letters  or  words 
are  not  distinctly  articulated.  There  is  still  more  stiffness  than  weak- 
ness in  the  limbs ;  and  a  yet  more  remarkable  symptom  observed  in 
these  patients,  until  extreme  weakness  prevents  it,  is  their  constant 
desire  for  walking  or  motion.  Dr.  Foville,  after  noticing  this,  adds, 
"One  of  my  patients,  when  first  attacked  by  this  complication,  would 
not  remain  in  the  same  place ;  he  walked  from  morning  till  night  with 
extreme  rapidity,  and  seemed  compelled  to  this  constant  exertion 
more  by  a  mechanical  impulse  than  by  a  voluntary  determination."^ 

The  same  author  also  notices  another  symptom  of  general  para- 
lysis of  the  insane,  which  I  have  described  as  frequently  occurring 
in  cases  of  spermatorrhoea,  "  In  the  course  of  this  disorder  I  have 
frequently  observed  attacks  of  cerebral  congestion  followed  by  convul- 
sions or  coma ;  these  lasted  several  hours,  and  were  frequently  repeated 
during  several  days.  After  such  attacks  the  intellectual  debility 
and  the  disorder  in  the  motions,  the  progress  of  which  is  generally 
equal,  become  more  marked.  In  many  patients  intervals  of  variable 
duration,  during  which  the  disease  made  no  progress,  were  inter- 
rupted by  these  attacks." 

I  have  quoted  these  passages  literally,  in  order  to  show  how  far 
the  symptoms,  which  I  have  described  as  belonging  to  spermator- 
rhoea, resemble  those  which  have  been  noticed  by  the  best  observers 
of  the  insane.     On  the  other  hand,  all  authors  admit  that  such  de- 


•  See   Dictionnaire    de   ]Meclecine,   et    de    Chirurgie    Pratiques,    art.    Alienation 
Mentale. 


GENERAL    SYMPTOMS.  295 

bility  of  the  muscular  system  does  not  exclusively  belong  to  insanity, 
and  that  it  occasionally  precedes  for  some  time  the  disorder  of  the 
intellectual  faculties. 

Lastly,  all  who  have  paid  attention  to  the  general  paralysis  of  the 
insane,  have  been  struck  with  the  great  difference  in  the  number  of 
the  two  sexes  attacked  by  this  serious  symptom.  In  a  statistical 
return  referring  to  334  cases  of  insanity,  Dr.  Foville  remarks  that 
out  of  31  cases  of  paralysis,  22  were  men  and  only  9  women.  Re- 
ports presented  by  various  other  observers  give  nearly  similar  pro- 
portions, notwithstanding  differences  of  climate,  manners,  &c.  Prof. 
Rech  has  stated  the  disproportion  to  be  even  more  considerable  in 
the  lunatic  asylum  at  Montpellier.  So  remarkable  and  constant  a 
difference  cannot  arise  from  any  accidental  cause,  for  the  number  of 
insane  females  surpasses  that  of  males.  It  seems  to  me,  therefore, 
that  the  great  frequency  of  general  paralysis  in  the  male,  should  be 
attributed  to  the  presence  of  diurnal  pollutions. 

I  have  just  stated  that  in  the  asylum  at  Charenton,  44  males  owed 
their  insanity  to  masturbation,  or  venereal  excesses,  whilst  only 
three  women  were  similarly  situated ;  and  I  have  also  noticed  the 
greater  frequency  of  recoveries  in  females  than  in  males.  It  is  im- 
possible not  to  be  impressed  with  the  harmony  that  exists  between 
these  three  important  facts,  constantly  and  generally  observed,  and 
to  which  no  cause  has  hitherto  been  assigned. 

Alterations  in  the  structure  of  the  brain  are  indeed  sometimes, 
found  in  cases  of  general  paralysis  of  the  insane,  but  even  those  who 
have  laid  most  stress  on  them  do  not  agree  as  to  their  importance. 
I  have  not  found  such  alterations  in  patients  dying  from  spermator- 
rhoea who  were  affected  by  the  same  muscular  weakness.  Besides, 
these  alterations  do  not  explain  why  the  general  paralysis  of  the 
insane  should  affect  males  in  so  much  greater  proportion  than  females. 

I  conclude,  therefore,  that  among  cases  of  incomplete  paralysis 
of  the  insane,  there  are  a  certain  number  depending  on  diurnal  pol- 
lutions, or  which  are  aggravated  by  this  disease,  as  I  have  already 
stated  with  regard  to  dementia. 

Dementia  and  general  paralysis  of  the  insane  have  been  generally 
regarded  as  certain  signs  of  the  incurability  of  the  insanity,  even 
when  only  slight  embarrassment  in  the  pronunciation,  hesitation  in 
the  motions,  or  trembling  of  the  limbs  existed.  Nevertheless,  simi- 
lar symptoms  have  always  disappeared  in  patients  suffering  from 
spermatorrhoea  as  soon  as  the  diurnal  pollutions  were  arrested. 
This  is  a  subject,  therefore,  which  demands  the  earnest  attention  of 
practitioners  who  have  opportunities  of  studying  it. 

General  character  of  the  symptoms. — Notwithstanding  the  number 
and  variety  of  the  effects  produced  by  spermatorrhoea,  it  is  evident 
that  all  arise  from  changes  in  the  functions  of  the  different  organs  ; 
and  by  comparing  these  changes  one  with  another,  the  same  cha- 
racters of  debility  and  disturbance  are  strikingly  seen  throughout. 


296  SYMPTOMS    OF    SPERMATOERHCEA. 

If  disorder  only  appear  to  be  present  in  certain  cases,  a  little  atten- 
tion will  show  that  it  is  accompanied  by  weakness  also. 

Involuntary  seminal  discharges  therefore  act  essentially  by  pro- 
ducing debility.  We  must  also  admit  that  these  discharges  excite 
a  powerful  and  rapid  influence  over  the  nervous  system  ;  hence  they 
have  always  been  justly  considered  enervating.  We  are  thus  able 
to  explain  the  numerous  and  varied  symptoms  resulting  from  sper- 
matorrhoea, as  well  as  their  resemblance  to  the  symptoms  produced 
by  all  other  debilitating  causes. 

Effects  of  masturbation  on  children  and  females. — In  children, 
even  at  a  very  early  age,  masturbation  produces  the  same  effects  as 
diurnal  pollutions ;  only  that  the  spasmodic  symptoms  are  generally 
more  marked  than  those  of  paralysis.  This  arises  from  the  pre- 
dominating power  of  the  nervous  system  at  this  early  age ;  for  the 
same  tendency  is  evinced  in  all  the  diseases  of  children,  and  even  in 
their  slight  indispositions.  On  the  other  hand,  however,  cases  more 
or  less  marked,  of  paralysis,  weakness  of  sight,  &c.,  are  not  rare ; 
and  loss  of  memory,  of  intellect,  and  of  the  affective  faculties,  are 
frequently  met  with,  and  may  reach  complete  brutishness. 

This  unfortunate  passion  produces  exactly  the  same  effects  in  the 
female  sex  at  all  ages  ; — the  relative  frequency  of  spasmodic  pheno- 
mena arising  from  the  greater  nervous  susceptibility  of  the  female. 
On  the  other  hand,  the  general  and  local  weakness,  occasional  in 
the  female,  also  resembles  paralysis.  I  have  recently  seen  a  case  of 
amaurosis,  arising  from  masturbation,  in  a  female  thirty-six  years  of 
age,  who  confessed  the  vice  when  leaving  the  hospital,  after  having 
submitted  to  issues,  setons,  moxas,  &c. 

In  these  numerous  cases,  therefore,  seminal  discharges  can  have 
no  influence  in  producing,  or  keeping  up  the  disease,  although  the 
symptoms  are  the  same  as  those  caused  by  spermatorrhoea. 
*  After  having  long  reflected  on  these  facts,  I  am  convinced  that 
the  effects  produced  by  seminal  discharges  may  be  brought  on  by  any 
other  debilitating  cause,  whose  action  on  the  economy  is  rapid  and 
important ;  and  that  of  all  such  causes  those  which  have  their  seat 
in  the  genital  organs  are  the  most  enervating,  and  consequently  the 
fittest  to  produce  debility  and  functional  disorder. 

Progress  of  the  symptoms. — In  examining  the  effects  produced  by 
spermatorrhoea,  I  have  for  obvious  reasons  generally  supposed  that 
the  disease  progresses  regularly  and  continuously :  such  is  not  the 
case,  however ;  the  symptoms  seldom  present  any  uniform  progress 
during  the  course  of  the  disease ;  nothing,  indeed,  can  be  more 
irregular,  even  in  the  most  severe  cases,  which  might  even  be  con- 
sidered continuous  when  compared  with  others.  Among  these  vari- 
ations some  may  be  considered  of  daily  occurrence,  and  these  are 
not  well  marked  ;  others,  again,  happen  less  often,  but  last  longer, 
and  are  most  important.  Numerous  causes  produce  these  irregu- 
larities in  the  progress  of  the  disease ;   variations  of  temperature, 


GENERAL    SYMPTOMS.  297 

hygrometric  influences,  atmospheric  pressure,  electrical  tension, 
varieties  of  food,  state  of  the  bowels,  and  numerous  other  trifling 
circumstances  produce  extraordinary  effects  on  persons  debilitated 
by  involuntary  seminal  discharges :  every  observing  practitioner 
will  note  these ;  I  need  not,  therefore,  enter  further  on  their  consi- 
deration. 

Spontaneous  Recovery. — Many  diseases  when  left  to  themselves 
work  their  own  cure,  provided  only  they  be  not  exasperated  by  the 
imprudence  of  the  patients.  This  is  not  the  case  with  spermator- 
rhoea— chiefly,  perhaps,  because  the  effects  produced  by  the  disease 
itself  are  favorable  to  the  increase  of  the  involuntary  discharges. 
The  natural  tendency  of  this  disease  to  become  aggravated,  as  the 
result  of  its  own  effects,  frequently  leads  to  fatal  termination.  The 
patients  under  these  circumstances  generally  expire  in  one  of  the 
attacks  of  syncope  that  follow  the  congestion  of  the  brain,  of  which 
I  have  already  spoken.  In  this  way,  also,  such  of  the  insane  who 
have  fallen  into  a  state  of  dementia,  generally  expire.  Death,  how- 
ever, in  cases  of  spermatorrhoea,  is  much  more  frequently  caused  by 
some  acute,  or  chronic  accidental  complication,  which  absorbs  all 
the  attention  of  the  attendants  on  account  of  its  being  more  evident 
and  better  known.  The  system  is  unable  to  resist  such  complica- 
tions on  account  of  its  previous  debility.  I  have  in  this  manner 
recently  seen  a  student,  who  was  debilitated  by  severe  diurnal  pollu- 
tions, carried  off  by  phthisis  after  only  two  months'  illness.  In  such 
cases,  unfortunately,  the  spermatorrhoea  is  generally  unsuspected. 


298  TREATMENT   OF    SPERMATORRHCEA. 


CHAPTER  XIII. 


TREATMENT    OF    SPERMATORRHOEA. 


Pollutions  arising  from  direct  causes. 

In  the  treatment  of  involuntary  seminal  discharges,  it  is  of  less 
consequence  to  seek  their  primary  than  to  discover  their  maintain- 
ing cause.  For  instance,  pollutions  may  have  been  primarily  ex- 
cited by  masturbation  or  venereal  excesses,  and  afterwards  be  kept 
up  by  affections  of  the  skin,  haemorrhoids,  kc.  In  such  cases  it  is 
evident  that  the  practitioner  must  treat  the  existing  cause.  Invo- 
luntary discharges  may  either  arise  from  actual  debility,  or  relaxa- 
tion of  the  spermatic  organs,  or  from  a  state  of  irritation,  or  chronic 
inflammation  of  the  parts,  after  having  been  first  produced  by  very 
different  remote  causes  ;  in  treating  such  cases,  then,  the  remote 
causes  are  not  to  be  considered,  while  too  much  importance  cannot 
be  attached  to  the  actual  condition  which  keeps  up  the  disease.  It 
is  this  actual  condition  of  these  spermatic  organs  that  m.ust  be  altered 
in  order  to  obtain  a  cure. 

This  point  must  never  be  lost  sight  of  in  considering  the  means 
to  be  employed  for  the  treatment  of  spermatorrhoea.  The  reme- 
dies are  numerous,  and  of  very  opposite  classes,  requiring  consider- 
able experience  and  skill  in  their  adaptation  to  the  temperament  or 
idiosyncrasy  of  each  patient,  as  well  as  to  the  different  stages  of 
the  disease. 

I  shall  arrange  these  remedies  in  different  groups,  according  to 
the  indications  to  be  fulfilled — beginning  by  considering  those  pol- 
lutions whose  causes  act  most  directly. 

Pollutions  arising  from  ascarides. — The  most  constant  symptom 
experienced  in  these  cases  is  an  insupportable  itching  at  the  anus. 
The  parts  on  examination  present  no  signs  of  eruption,  but  the 
mucous  membrane  lining  the  sphincter  is  red,  injected,  and  covered 
with  thick  mucus,  sometimes  mixed  with  blood.  There  are  also 
numerous  little  red  points,  which,  as  well  as  the  itching,  arise  from 
the  pricking  produced  by  the  tails  of  the  worms.  Sometimes  pa- 
tients, annoyed  at  the  constant  itching,  introduce  the  finger  into  the 
anus,  detach  some  ascarides,  and  bring  them  away  under  the  nail. 


POLLUTIONS    ARISING    FEOM    ASCARIDES.  299 

The  sensations  experienced  are  not  the  same  at  all  times ;  they  are 
generally  much  more  severe  at  certain  parts  of  the  day,  apparently 
depending  on  the  times  of  taking  food ; — the  itching  notably  in- 
creasing about  four  or  five  hours  after  dinner.  The  stools  are  ge- 
nerally passed  easily,  are  soft,  very  fetid,  and  covered  with  a  large 
quantity  of  thick  ropy  mucus,  often  filled  with  blood. 

Diarrhoea  frequently  occurs,  constipation  under  these  circum- 
stances being  very  rare. 

In  these  cases,  therefore,  the  pollutions  are,  as  I  have  before  said, 
not  caused  by  pressure  on  the  seminal  vesicles,  but  by  their  spasmo- 
dic contraction  produced  by  the  irritation  of  the  surrounding  parts. 
The  pollution  generally  occurs  while,  the  patient  is  occupied  in  ad- 
justing his  dress  ;  it  takes  place  suddenly,  and  is  ordinarily  preceded 
by  two  or  three  spasmodic  contractions  of  the  rectum. 

Darting  pains  from  the  base  of  the  penis  to  the  extremity  of  the 
glans,  are  also  frequently  felt  in  these  cases:  these  pains  bear  con- 
siderable analogy  to  those  caused  by  the  presence  of  stone  in  the 
bladder,  the  patients  elongating  the  prepuce  for  relief  in  the  same 
manner  as  in  that  disease.  These  pains  are  most  likely  caused  by 
the  ascarides  pricking  that  portion  of  the  rectum  which  covers  the 
prostate. 

Ascarides  always  inhabit  the  lower  portion  of  the  large  intestine, 
and  may,  therefore,  be  attacked  by  direct  means — the  most  simple 
of  all,  without  exception,  being  injections  of  water.  When  thrown 
up  at  a  sufiiciently  low  temperature,  water  kills  these  worms,  or  at 
least  stupefies  them,  and  when  injected  in  considerable  quantity,  so 
as  to  be  returned  with  some  force,  they  are  frequently  passed  even 
whilfe  alive.  The  injections  may  be  commenced  at  a  temperature 
of  75°  Fah.  and  may  afterwards  be  reduced  to  60°  or  even  70°  of 
the  same  scale.  It  is  important  to  throw  up  as  much  water  as  pos- 
sible, because  by  this  means  the  worms  furthest  from  the  anus  may 
be  reached,  and  those  which  are  adherent  to  the  walls  of  the  in- 
testine may  be  detached.  Ascending  douches  are  very  useful  in 
these  cases — their  action  being  that  of  a  powerful  and  long  con- 
tinued enema  syringe. 

These  injections  should  especially  be  used  in  the  evening,  five  or 
six  hours  after  the  last  full  meal,  because  this  is  the  time  when  the 
itching  at  the  anus  caused  by  the  worms  is  chiefly  felt ;  besides 
which,  cold  injections  administered  at  this  period  are  of  use  to  the 
patients  for  other  reasons.  They  render  the  worms  which  remain 
less  lively,  cool  the  irritated  intestine,  diminish  the  erections,  and 
place  the  patients  in  the  most  favorable  condition  to  obtain  that 
sound  sleep  of  which  they  are  greatly  in  need. 

Cold  water  is,  perhaps,  the  least  active  injection  we  can  employ, 
since  it  has  no  action  except  that  derived  from  its  low  temperature ; 
but  on  this  account  alone  it  is  often  preferable  to  injections  that  act 
chemically.  The  latter  are  always  more  or  less  styptic,  acrid,  or 
irritant,   and  cannot  destroy   the  ascarides  •without  acting  on  the 


300  TEEATMENT    OF    SPERMATORRHCEA. 

mucous  membrane  of  the  intestine,  which  is  already  irritated  and  fre- 
quently even  inflamed :  it  is,  therefore,  prudent  to  begin  by  copious 
injections  of  water,  which  should  at  first  even  be  used  at  a  moderate 
temperature,  as  a  very  cold  injection,  Avhen  the  intestine  is  unaccus- 
tomed to  it,  may  produce  a  very  injurious  irritating  effect.  When 
the  mucous  membrane  of  the  intestine  has  in  some  degree  recovered 
its  tone,  salt  and  water  injections  may  be  used — the  quantity  of  salt 
being  gradually  increased  from  one  to  three  tablespoonfuls  to  the 
quart  of  water.  Two  or  three  of  these  injections  should  be  adminis- 
tered in  rapid  succession,  or,  better  still,  should  be  retained  so  as 
to  carry  the  fluid  as  high  up  the  intestine  as  possible  ;  care  must, 
however,  be  taken  that  the  solution  does  not  contain  too  much  salt, 
which  would  irritate  the  mucous  membrane. 

Decoctions  made  from  plants  of  the  genus  artemisia  are  very  use- 
ful as  injections  in  these  cases ;  some  of  them,  however,  are  some- 
what irritating  to  the  mucous  membrane.  The  class  Lahiata  are  less 
irritant,  but  their  vermifuge  power  is  less  also.  Whatever  be  the 
injection  employed,  care  must  be  taken  that  it  be  not  too  concentrated. 
When  this  is  the  case,  the  intestine  may  become  irritated,  and  this 
irritation  may  extend  to  the  bladder,  producing  very  annoying 
symptoms  and  rendering  narcotic  and  emollient  injections  and  baths 
necessary. 

A  small  quantity  of  the  unguentiim  liydrargyri  mitius  introduced 
into  the  intestine,  often  puts  an  immediate  stop  to  the  annoyance 
produced  by  ascarides  ;  the  itching  returns,  however,  the  worms  in 
the  immediate  neighborhood  of  the  anus  being  alone  affected  by 
this  remedy.  The  bichloride  of  mercury  in  very  diluted  solution 
is  also  an  active  remedy,  but  it  requires  great  care  and  circumspec- 
tion in  its  use. 

All  purgative  enemata  destroy  ascarides,  but  at  the  same  time  irri- 
tate the  mucous  membrane.  Oily  injections  are,  however,  unirri- 
tating,  and  consequently  very  useful.  Camphorated  solutions  have 
been  recommended ;  but  although  their  action  on  the  ascarides  is 
very  prompt,  I  think  there  are  sufiBcient  reasons  to  contraindicate 
their  employment. 

In  very  young  children  baths  may  be  employed  containing  an  in- 
fusion of  one  of  the  genus  artemisia.  I  have  even  frequently  seen 
these  followed  by  the  expulsion  of  hLinhrici,  when  no  other  means 
had  been  employed. 

It  seldom  happens,  however,  that  injections  alone  suffice  for  the 
entire  removal  of  ascarides,  some  of  which  often  inhabit  the  upper 
parts  of  the  large  intestine,  and  are  consequently  unaffected  ;  it  is 
therefore  generally  necessary  to  administer  vermifuge  remedies  by 
the  mouth.  Calomel  has  always  appeared  to  me  to  be  the  most  effi- 
cacious of  these :  when  the  stomach  is  much  disordered  it  is  best  to 
give  from  two  to  four  grains  of  calomel  at  bedtime;  and  this  may 
be  followed  by  a  moderate  dose  of  castor  oil  taken  early  in  the  morn- 
ing. 


POLLUTIONS    CAUSED    BY    CUTANEOUS    ERUPTIONS.      301 

At  the  same  time  that  these  remedial  agents  are  employed,  means 
must  be  taken  to  improve  the  general  health,  and  especially  the 
state  of  the  digestive  organs.  It  must  be  recollected  that  the  pre- 
sence of  worms  is  a  sure  sign  of  deficient  energy  in  the  intestinal 
tube  ;  and  this  is  generally  conjoined  with  constitutional  debility, 
and  is  only  to  be  remedied  by  fortifying  the  whole  system. 

Pollutions  excited  hy  Cutaneous  Eruptions. — Eruptions  occur  at 
the  margin  of  the  anus,  causing  insupportable  itching,  with  abundant 
ichorous  discharge,  and  excoriation  of  the  skin  and  raucous  membrane 
lining  the  sphincter  ani.  Sometimes  the  affection  extends  more 
deeply  in  the  intestine,  and  then  an  increased  secretion  of  mucus 
takes  place.  The  irritation  set  up  under  these  circumstances  excites 
spasmodic  contractions  of  the  seminal  vesicles,  and  consequently, 
pollutions,  especially  those  which  occur  during  defecation. 

Other  eruptions  occur  on  the  prepuce  (herpes  preputialis).  These 
consist  of  furfuraceous  patches,  little  pointed  pimples,  or  phlyctenoid 
swellings  resembling  the  effects  of  stinging  by  nettles  ;  or  again  in 
more  or  less  lively  erysipelatous  redness.  These  different  eruptions 
are  generally  attended  by  swelling  of  the  prepuce,  with  hardening 
or  infiltration  of  the  loose  cellular  tissue  of  the  part,  and  increased 
secretion  of  the  sebaceous  matter,  with  intolerable  itching.  This 
sebaceous  secretion  often  becomes  acrid  enough  to  excoriate  the  glans 
and  internal  surface  of  the  prepuce.  The  patient  cannot  keep  his 
fingers  from  the  parts,  which  again  grow  more  disordered  in  propor- 
tion to  his  attempts  to  obtain  relief  from  the  itching.  Sometimes, 
too,  a  degree  of  salacity  is  present,  which  has  no  relation  whatever 
with  the  patient's  real  powers.  Eruptions  occurring  on  the  skin  of 
the  penis,  scrotum,  perineum,  groins,  pubes,  and  the  insides  of  the 
thighs,  may  produce  nearly  the  same  effects. 

Sometimes  urethral  discharges  just  as  profuse  and  painful  as  those 
caused  by  blennorrhagic  virus  occur  in  these  cases ;  and  these  may 
be  followed  by  inflammation  of  the  testicles  or  bladder,  or  even 
nephritis. 

The  eruptions  may  also  suddenly  leave  the  genital  or^ajis  and 
commence  in  some  other  part  of  the  body  ;  and  when  this  hA'^pens, 
the  pollutions  generally  cease  for  the  time,  to  return  again  with  the 
return  of  the  disease  to  its  old  seat. 

In  the  treatment  of  these  cases  it  is  always  necessary  to  begin  by 
using  baths  of  either  the  natural  or  artificial  sulphuretted  waters. 
Care  must  be  taken  that  these  baths  be  neither  too  strong  nor  too 
hot  ;  artificial  sulphuretted  baths  should  at  first  only  contain  a 
small  proportion  of  sulphuret  of  potassium,  and  their  strength  and 
temperature  may  be  gradually  increased.  The  natural  waters  are 
frequently  of  too  high  a  temperature  for  these  excitable  subjects  ; 
from  80°  to  90°  Fah.  is  generally  quite  sufficiently  warm  for  the 
first  trials. 

After  the  natural  sulphuretted  waters  have  been  used  as  baths 


302  TREATMENT    OF    SPERMATORRH(EA. 

for  some  little  time,  they  may  be  taken  internally  and  employed  as 
douches  on  the  perineum  and  loins,  and  as  enemata,  or  as  ascending 
douches,  into  the  rectum.  The  direct  action  of  douches  on  the  cuta- 
neous tissues  is  very  important ;  in  consequence  of  the  percussion, 
the  water  stimulates  the  skin  much  more  than  when  simply  used  in 
baths.  I  have  often  seen  eruptions  that  had  long  withstood  the 
remedial  action  of  sulphuretted  waters  taken  internally,  with  the 
simultaneous  use  of  baths,  cured  in  a  few  days  by  douching  the 
affected  part. 

In  eruptions  about  the  anus,  we  have  no  remedy  equal  to  ascend- 
ing douches,  especially  where  the  disease  extends  to  the  mucous 
membrane  of  the  gut — this  structure  being  acted  on  as  well  as  the 
skin  of  the  anus.  Injections  into  the  bladder  by  means  of  a  double 
catheter  are  useful  in  some  cases  of  chronic  discharge  from  the  lining 
membrane  of  that  organ ;  but  here  great  care  is  necessary,  and  the 
stream  should  be  rather  continuous  than  powerful. 

Sometimes  the  immediate  effect  of  sulphuretted  waters  is  to  pro- 
duce a  degree  of  excitement  that  increases  the  involuntary  discharges. 
The  final  results  are,  however,  almost  sure  to  be  favorable. 

Occasionally,  again,  good  effects  are  experienced  at  first,  but  after- 
wards disappear  :  new  attacks  of  urethral  irritation  come  on  accom- 
panied with  discharge,  »Stc.,  as  before,  and  referable  to  contagion.  I 
have  known  such  relapses  occur  four  or  five  times,  notwithstanding 
the  annual  use  of  sulphuretted  waters,  and  other  treatment. 

In  such  cases  it  becomes  necessary  to  remove  the  condition  of  the 
mucous  membrane  that  keeps  up  the  irritation  ;  and  this  result  can 
only  be  permanently  obtained  by  cauterization. 

On  the  other  hand,  again,  the  use  of  sulphuretted  waters  is  often 
highly  advantageous  in  cases  that  do  not  depend  on  cutaneous  dis- 
ease—  those  that  are  due  to  a  too  great  susceptibility  of  the  genital 
organs  for  instance.  The  mildest  class  of  waters  should  be  chosen 
under  such  circumstances,  and  great  circumspection  is  necessary  in 
their  employment. 

In  all  cases  in  which  the  sulphuretted  waters  are  employed,  care 
must  be  taken  to  warn  the  patient  against  the  injurious  modes  of  life 
so  frequent  among  the  society  frequenting  mineral  springs. 

Pollutions  arising  from  Altered  or  Increased  Secretions  from  the 
Sebaceous  Grlands. — The  sebaceous  matter  of  the  prepuce  and  glans 
is  sometimes  very  abundant  in  quantity,  and  remarkably  acrid 
especially  in  individuals  subject  to  cutaneous  eruptions.  In  other 
cases  it  may  be  retained  by  great  length  of  the  prepuce,  or  nar- 
rowness of  the  preputial  orifice.  Under  such  circumstances,  the 
irritation  of  the  glans  penis  may  bring  on  very  serious  nocturnal  and 
diurnal  pollutions. 

Whenever  the  prepuce  is  too  long  or  its  orifice  too  narrow,  it  is 
indispensable  to  commence  the  treatment  by  its  removal.  This  in 
many  cases  suffices;  others,  however,  require  astringent  lotions,  sul- 


I 


POLLUTIONS    DEPENDING    ON    STRICTURE.  303 

phuretted  baths,  lotions  containing  a  small  proportion  of  spirit,  &c. 
Simple  division  of  the  prepuce  does  not  suffice  in  these  cases;  in- 
deed, for  reasons  well  known  to  surgeons  of  the  present  day,  its 
entire  removal  is  generally  to  be  preferred.  Where  the  preputial 
orifice  is  very  narrow,  and  the  part  itself  so  scanty  as  to  be  firmly 
applied  over  the  glans,  this  can  only  be  accomplished  by  first  slitting 
up  the  organ  and  afterwards  removing  the  flaps  thus  made.  The 
operation  being  a  familiar  one,  further  details  are  unnecessary. 

Pollutions  depending  on  Stricture  of  the  Urethra. — Spermator- 
rhoea may  either  be  brought  on  by  stricture  of  the  urethra,  or  being 
brought  on  by  some  other  of  the  various  causes,  may  be  kept  up  by 
this  disease.  In  both  cases  the  most  urgent  indication  is  the  same. 
The  involuntary  discharges  cannot  be  removed  without  first  removing 
the  obstacle  to  the  free  discharge  of  urine. 

Various  means  have  been  employed  for  this  purpose,  some  of 
which  are  specially  suited  to  particular  cases. 

In  an  immense  majority  of  cases,  dilatation  properly  applied,  is 
all  that  is  required  ;  and  again,  dilatation  may  be  employed  by  two 
different  methods,  the  comparative  merits  of  which  I  must  hastily 
glance  at. 

Formerly,  strictures  were  always  treated  by  dilatation  continued 
over  a  period  of  two  or  three  months,  and  this  alone  was  supposed  to 
preserve  the  patients  from  the  danger  of  a  relapse.  This  dilatation 
was  generally  performed  by  means  of  gum-elastic  catheters  retained 
in  the  passage.  Chronic  vesical  catarrhs  very  frequently  resulted — 
continuing  after  the  removal  of  the  instrument ;  and  the  mucous 
membrane  of  the  urethra  was  generally  much  altered  in  structure, 
becoming  fungoid  and  injected.  The  pressure  of  the  extremity  of 
the  catheter  on  the  walls  of  the  bladder,  too,  often  had  dangerous 
results  ;  and  more  than  once  the  vesical  coats  have  been  perforated — 
becoming  softened  by  inflammation — and  effusion  of  urine  into  the 
peritoneal  cavity  has  taken  place,  of  course  followed  by  speedy  death. 

Abscesses  in  the  prostate,  also,  have  frequently  formed,  and  either 
discharged  into  the  bladder,  or  rectum,  or,  producing  hard  swelling 
in  the  perineum,  been  promptly  opened  by  the  surgical  attendant. 
The  serious  results  of  these  abscesses  are  well  known  to  all  practical 
men. 

Inflammation  of  the  testicle,  too,  is  a  frequent  attendant  on  the 
slow  dilatation  of  strictures  ;  and  even  when  this  does  not  take  place, 
the  mucous  membrane  of  the  prostate  is  generally  thickened  and 
altered  in  structure — the  ejaculatory  canals  and  vasa  deferentia  par- 
ticipating in  the  morbid  action. 

Inflammation  is  frequently  set  up  in  the  corpus  spongiosum  and 
cellular  tissue  surrounding  it ;  and  this  may  either  go  on  to  suppu- 
ration, and,  if  not  opened  early,  ultimately  form  urinary  fistula,  or, 
the  inflammation  becoming  chronic,  one  of  the  hard  tumors  found 
in  such  cases  may  result. 

By  rapidly  dilating  the  stricture,  these  inconveniences  are  avoided. 


304  TREATMENT  OF  SPEEMATORRH(EA. 

A  metallic  catheter  should  always  be  employed,  because  it  is  more 
easily  directed  and  the  surgeon  is  better  able  to  feel  the  progress  he 
makes.  When  the  stricture  is  situated  in  front  of  the  scrotum,  how- 
ever, a  straight  instrument  may  be  used.  Whenever  the  contraction 
is  passed,  the  instrument  should  be  retained  during  seven  or  eight 
hours,  after  which  a  gum-elastic  catheter  of  the  same  size  may  be 
substituted.  The  stricture  is  thus  compressed,  and  the  gorged  cel- 
lular tissue  subsides,  so  that  after  three  or  four  hours  more  the  in- 
strument becomes  loose  and  may  be  easily  replaced  by  one  of  a  size 
larger.  If,  however,  the  instrument  be  not  loose  in  the  passage  at 
the  expiration  of  this  period,  it  should  be  left  a  few  hours  longer. 
By  proceeding  in  this  manner  every  four  hours  within  two  days,  the 
largest  catheter  the  urethra  will  contain,  may  be  easily  passed  into  the 
stricture — each  new  introduction  of  a  larger  instrument  being  easier 
and  less  painful  than  the  preceding.  As  a  rule,  strictures  which  are 
not  very  narrow  or  resistant,  are  cured  without  relapse  by  this  simple 
proceeding,  but  old,  resistant,  and  lengthy  strictures  again  contract. 
After  a  certain  time,  the  patients  perceive  a  diminution  in  the  stream 
of  urine,  and  when  this  takes  place  slowly  and  without  evident 
cause,  dilatation  must  again  be  had  recourse  to,  commencing  by  the 
introduction  of  the  largest  catheter  which  will  pass  the  contraction. 
Sometimes,  however,  the  stream  of  urine  becomes  suddenly  diminished 
after  excesses  of  any  kind,  horse  exercise,  &c.,  and  under  these  cir- 
cumstances, baths  should  be  used  with  emollients,  to  remove  the  ac- 
cidental irritation.  Where  it  is  necessary  to  have  recourse  a  second 
time  to  mechanical  dilatation,  perfect  results  are  generally  obtained 
in  half  a  day,  or  at  most  in  twenty-four  hours,  the  stricture  not 
having  been  permitted  to  attain  its  former  degree  of  contraction.  The 
patient  may  now  be  instructed  to  pass  the  instrument  for  himself,  and 
recommended  to  have  recourse  to  the  method  of  rapid  dilatation 
whenever  the  same  indications  present  themselves.  The  periods  of 
contraction  of  the  stricture  become  more  and  more  distant,  and 
even  in  the  most  refractory  cases,  perhaps,  do  not  recur  for  years. 

The  plan  of  rapid  dilatation  possesses,  therefore,  all  the  advan- 
tages of  the  slow  process,  without"  its  inconveniences. 

Cases  of  traumatic  stricture,  such  as  those  caused  by  a  fall  on  the 
perineum,  &c.,  are  exceptions  to  this  rule.  The  long-continued 
presence  of  a  catheter  is  indispensable  in  these  cases ;  indeed,  they 
are  difficult  of  cure  by  any  means. 

There  are  some  cases  of  stricture,  however,  in  which,  notwithstand- 
ing the  numerous  advantages  of  rapid  dilatation,  it  must  give  way  to 
other  means.  When  the  stricture  is  situated  at  the  orifice  of  the 
glans,  dilatation  cannot  be  had  recourse  to  without  causing  extreme 
pain,  besides  which  the  contraction  readily  returns.  Incising  the 
stricture  in  the  direction  of  the  frsenum,  is  a  much  simpler  and  more 
rapid  means  of  cure.  The  union  of  the  wound  must  be  prevented 
by  passing  daily,  for  a  week  or  so,  the  extremity  of  a  large  bougie 
just  into  the  canal.     The  lips  of  the  wound  being  prevented  from 


POLLUTIONS    DEPENDING    ON    STRICTURE,  305 

uniting,  cicatrize  separately,  and  there  is  no  danger  of  a  return  of  the 
contraction.  Even  when  the  stricture  is  situated  two  or  three  lines 
within  the  orifice,  incision  with  a  straight  probe-pointed  bistoury  may 
be  had  recourse  to  with  advantage. 

There  are  also  some  annular  strictures  which,  from  their  elasticity, 
return  rapidly  to  their  former  degree  of  contraction,  as  soon  as  the 
dilating  instrument  is  removed.  These  strictures  should  be  scari- 
fied in  different  parts  of  their  circumference,  by  a  bistouri  cachee 
adapted  to  the  purpose,^  and  afterwards  full-sized  instruments  should 
be  introduced  daily  for  an  hour  or  two. 

Some  strictures  bleed  from  very  slight  causes,  and  others,  again, 
are  extremely  sensitive.  In  both  these  cases  dilatation  is  objection- 
able— indeed,  in  certain  cases  of  irritable  stricture,  the  patients  are 
unable  to  submit  to  it  on  account  of  the  agony  produced,  frequently 
followed  by  fever,  rigors,  &c.  In  these  cases  cauterization  of  the 
irritable  surface  with  the  nitrate  of  silver  is  the  only  means  by  which 
a  prompt  and  permanent  cure  can  be  obtained. 

Lastly,  there  are  impediments  to  the  discharge  of  urine  situated 
externally  to  the  mucous  membrane.  These  consist  of  little  tumors 
developed  in  the  spongy  tissue  of  the  urethra,  or  even  still  more 
superficially  ;  these  tumors  can  only  be  dispersed  by  external  inci- 
sion. A  large  catheter  should  be  passed  into  the  urethra,  so  as  to 
cause  the  tumor  to  project  beneath  the  skin,  which  should  then  be 
freely  divided  with  a  straight  bistoury;  the  cellular  tissue  and  tumor 
are  in  their  turns  to  be  treated  in  the  same  manner.  The  tumor 
afterwards  suppurates  and  disappears  completely. 

Pollutions  arising  from  Haemorrhoids. — Hemorrhoids  may  cause 
involuntary  seminal  discharges  in  two  ways — by  the  irritation  they 
excite — and  by  acting  as  mechanical  impediments  to  defecation. 

In  the  first  case  the  tumors  become  swollen  and  painful,  and  the 
irritation  extends  to  the  prostate  and  neck  of  the  bladder.  Vegetable 
and  milk  diet  should  be  used  in  these  cases,  with  warm  baths,  cold 


'  The  instrument  to  be  used  for  this  purpose  should  not  be  constructed  on  the 
principle  of  a  lancet-shaped  stilet.  In  pushing  forward  the  pointed  extremity  of  such 
an  instrument  it  is  almost  impossible  to  be  assured  of  the  direction  in  which  the  in- 
cision is  made  ;  besides  which  the  elasticity  of  the  stricture  will  allow  it  to  give  way 
before  the  point  of  the  instrument,  however  well  set,  when  the  thrusting  motion  alone 
is  depended  on  to  produce  the  required  effect.  In  all  cases,  too,  for  which  this  opera- 
tion is  suited,  it  is  possible  to  dilate  the  stricture  by  means  of  a  somewhat  conical  in- 
strument. It  is  far  better,  therefore,  that  the  bistouri  cach(^e  should  be  sheathed  in 
the  substance  of  a  solid  sound,  and  made  to  project  slightly  by  means  of  a  screw,  after 
the  instrument  has  been  passed  entirely  through  the  stricture,  the  incisions  or  notches 
in  which  may  thus  be  made  while  withdrawing  the  instrument,  and  with  a  proper  cut- 
ting motion.  For  strictures  in  front  of  the  perineum,  a  straight  instrument  may  be 
used,  and  this  will  have  the  advantage  of  being  turned  round  in  the  urethra  so  as  to 
notch  several  parts  of  the  stricture.  For  strictures  nearer  the  bladder  several  instru- 
ments will  be  required,  if  it  be  necessary  to  incise  more  than  one  aspect  of  the  stric- 
ture. In  all  cases  the  projection  of  the  bistouri  cachee  should  be  regulated  by  means 
of  a  screw,  so  that  the  exact  depth  to  which  the  incision  will  extend,  may  be  known 
by  a  single  glance  at  the  handle  of  the  instrument.     [H.  J.  McD.] 


306  TREATMENT    OF    SPERMATOERH(EA. 

and  opiate  enemata,  and  emollient  poultices  when  the  tumors  be- 
come prolapsed  and  painful.  In  this  state,  too,  much  and  immediate 
relief  may  be  obtained  by  puncturing  the  most  distended  tumors  with 
a  lancet ;  the  swelling  goes  down,  the  pain  is  relieved,  and  often  the 
hcTemorrhoid  withers  away  and  becomes  completely  obliterated.  The 
practice  of  applying  leeches  to  these  tumors  cannot  be  too  much 
reprobated.  The  leech-bites  increiise  the  irritation,  and  it  is  evident 
that  the  effect  desired,  viz.,  that  of  emptying  the  tumor  of  its  con- 
tents, cannot  be  accomplished  by  these  creatures,  their  bite  not  being 
sufficiently  deep  to  extend  through  the  coats  of  the  tumor. 

When  the  hgemorrhoids  are  sufficientl}'  large  and  numerous  to  im- 
pede defecation,  they  must  be  unhesitatingly  removed — especially 
when  they  become  hard  and  begin  to  dege'nerate.  Care  must  be 
taken  in  operating  for  the  removal  of  these  tumors  when  internal  to 
the  sphincter,  to  cauterize  the  bleeding  surface  with  the  heated  iron, 
after  each  stroke  of  the  knife.^  There  is  no  occasion  to  form  a  deep 
slough — it  is  simply  necessary  to  close  the  oriSces  of  the  bleeding 
vessels.  For  this  purpose  the  small  olive-shaped  cauterizing  irons 
are  the  most  convenient. 

Pollutions  caused  by  Cicatrices  in  the  Neigliborhood  of  the  Anus. 
— Accidental  cicatrices  in  the  neighborhood  of  the  anus,  or  within 
the  rectum,  may  cause  very  serious  pollutions  on  account  of  the  ob- 
stacle they  present  to  free  defecation.  It  is  evident  that  these  pollu- 
tions can  only  be  relieved  by  incising  such  cicatrices,  and  prevent- 
ing the  union  of  the  incisions  by  introducing  an  instrument  capable 
of  dilating  the  part  to  the  full  dimensions  of  the  rectum. 

Pollutions  caused  hy  Fissure  of  the  Anus. — I  need  not  repeat  what 


'  When  hoemorrhoius  are  situated  ■within  the  sphincter  ani,  their  removal  by  the 
knife  is  dangerous  with  any  amount  of  caution.  It  is  fur  better,  by  directing  the 
patient  to  strain  as  at  stool,  to  cause  the  tumors  to  project  beyond  the  sphincter,  and 
then  to  transfix  them  through  the  base  with  a  fixed  needle  carrying  a  double  ligature. 
An  unarmed  needle  maj'  be  passed  underneath  the  first,  and  the  ligatures  tied  on  each 
side,  underneath  the  second  needle.  This  proceeding  causes  little  pain  when  the  por- 
tions strangulated  consist  only  of  mucous  membrane  ;  should,  however,  a  portion  of 
sliin  be  included,  the  suffering  is  generally  intense — ample  reason  for  avoiding  the  ap- 
plication of  a  ligature  when  the  piles  are  external.  The  strangulated  portions  seldom 
give  any  further  trouble,  and  unless  the  stools  be  carefully  examined,  even  the  liga- 
tures are  generally  discharged  unnoticed. 

The  ligatures  for  this  purpose  should  consist  of  fine,  smooth,  even,  and  very  strong 
whip-cord.  Silk,  however  often  doubled,  will  seldom  bear  the  force  required  to  draw 
the  ligature  tight,  and,  besides,  this  repeated  doubling  makes  a  thick  cord  which  does 
not  so  perfectly'  strangulate  the  tumor.  In  external  haemorrhoids,  when  recent  and 
inflamed,  the  practice  of  puncturing  with  a  lancet  cannot  be  too  strongly  recom- 
mended. The  hemorrhage  that  takes  place  relieves  the  congestion  of  the  haemor- 
rhoidal  veins  as  well  as  the  irritation  of  the  neighboring  parts,  and  by  gently  pressing 
the  tumor,  if  it  have  not  already  disappeared  on  the  following  day,  a  small  clot  will 
generally  be  discharged,  after  which  the  pile  will  for  the  most  part  shrink  up  and 
give  no  further  trouble.  When,  however,  external  piles  are  of  long  standing,  they 
should  be  freely  removed  by  the  knife.  Smart  hemorrhage  sometimes  follows,  con- 
tinuing for  a  few  minutes ;  no  danger  is  to  be  apprehended  from  this,  as  it  soon  ceases 
spontaneously,  or  at  all  events,  may  be  immediately  arrested  by  light  pressure  with 
a  compress  of  lint.     [H.  J.  McD.] 


POLLUTIONS    CAUSED    BY    CONSTIPATION.  307 

I  have  already  said  respecting  the  diiferent  modes  bj  means  of  which 
anal  fissures  may  cause  pollutions.  The  action  is  precisely  the  same 
as  that  of  heeraorrhoids. 

The  indication  to  be  fulfilled  is  of  course  to  obtain  a  cure  of  the 
fissure,  and  this  is  only  to  be  accomplished  in  severe  cases  by  di- 
viding the  sphincter  ani.'  This  operation  must  be  performed  to- 
wards the  side  opposite  to  that  on  which  the  fissure  is  situated.^ 
With  regard  to  the  treatment  after  the  operation  I  must  remark, 
that  I  consider  the  plan  of  stuffing  the  wound  with  charpie  injurious 
and  inconvenient ;  great  irritation  often  results  from  it,  and  fre- 
quently hemorrhage  is  kept  up,  which  would  otherwise  speedily  cease. 
The  wounds  heal  just  as  perfectly  without  this  dressing,  and  I  have 
lately  given  up  its  use  in  all  cases  where  division  of  the  sphincter 
ani  is  required.^ 

There  are  some  cases  of  anal  fissure  which  apparently  depend  on 
a  syphilitic  taint.  These  are  readily  cured  by  the  introduction  of  a 
small  suppository  containing  mild  mercurial  ointment.^ 

Pollutions  produced  by  Constipation. — Constipation  is  sometimes 
the  cause  of  spermatorrhoea ;  but  it  is  much  more  frequently  one  of 
the  results  of  the  disease;  at  all  events,  costiveness  is  almost  always 
an  accompaniment  of  it.  In  all  cases  it  is  undoubtedly  of  importance 
to  relieve  the  constipation,  even  when  it  is  not  the  primary  cause  of 
the  disease.  Both  surgeons  and  patients,  however,  have  for  the 
most  part  fallen  into  a  strange  error  in  considering  that  to  cure  the 
pollutions  it  is  sufficient  to  procure  free  evacuations  of  the  bowels. 

Diurnal  pollutions,  indeed,  which  are  simply  accidental,  disappear 
as  soon  as  the  momentary  costiveness  causing  them  has  been  relieved  ; 


1  The  free  application  of  the  nitrate  of  silver  in  substance  will  relieve  many  cases 
of  fissure  of  the  anus,  even  when  very  severe.  The  application  gives  sharp  momen- 
tary pain,  but  this  soon  passes  off,  and  great  relief  is  immediately  afterwards  expe- 
rienced.    [H.  J.  McD.] 

2  When  the  fissure  is  not  situated  in  the  anterior  portion  of  the  anus — the  direction 
of  the  urethra — this  operation  may  be  performed  by  simply  dividing  the  parts  through 
the  fissure.  The  irritable  surface  is  thus  converted  into  a  simple  wound,  which  in- 
flames, suppurates,  and  generally  heals  without  further  trouble. 

In  all  cases  of  fissure  of  the  anus,  as  well  as  in  cases  of  haemorrhoids — indeed,  in 
all  affections  of  the  lower  bowel — too  much  attention  cannot  be  paid  to  the  state  of  the 
digestive  organs  and  liver.  It  must  be  recollected  that  disorder  of  these  viscera  is 
by  far  the  most  frequent  cause  of  rectal  disease,  and  that  without  first  removing 
such  cause  no  local  treatment  can  be  permanently  successful.     [H.  J.  McD.] 

3  There  can  be  no  doubt  as  to  the  propriety  of  avoiding  the  filthy  dressings  still  too 
often  used,  and  the  abominable  practice  of  stuffing  up  wounds  made  by  operation  on 
the  lower  bowel.  In  all  cases  when  any  dressing  is  required,  a  narrow  strip  of  lint, 
dipped  in  a  little  tepid  water,  suffices.  In  the  after  treatment  of  divided  sphincter 
ani,  an  aromatic  lotion — the  red  wash  of  the  University  College  Hospital — consisting 
of  about  a  scruple  of  sulphate  of  zinc,  four  drachms  of  spirits  of  rosemary,  one  drachm 
of  compound  tincture  of  lavender  and  ten  ounces  of  water — is  generally  the  only  ap- 
plication necessary.     [H.  J.  McD.] 

*  The  origin  of  such  fissures  from  a  syphilitic  taint,  I  cannot  but  consider  very 
doubtful.  Certainly  the  local  application  of  the  mild  mercurial  ointment  would,  ac- 
cording to  the  generally  received  notions  of  constitutional  syphilis,  be  of  very  little 
efficacy  in  curing  a  secondary  sore.     [H.  J.  McD.] 


808  TREATMENT    OF    SPERMATORRHCEA. 

but  in  such  cases  spermatorrhoea  has  not  become  a  confirmed  disease, 
and  the  health  is  not  seriously  disordered. 

On  the  other  hand,  I  have  met  with  cases  in  which  diurnal  pollu- 
tions brought  on  by  old  standing  and  obstinate  costiveness,  continued 
after  the  bowels  had  been  restored  to  their  normal  action.  Case 
nineteen  is  a  striking  example  of  this. 

The  means  generally  employed  to  relieve  constipation  are  so  well 
known,  that  I  need  not  consider  them  separately.  Ascending  douches 
are  in  my  opinion  by  far  the  most  efficacious  and  useful  in  all  cases.^ 
Purgatives  on  the  other  hand  are  injurious,  however  administered 
and  of  whatever  nature  they  may  be ;  laxatives,  such  as  castor  oil, 
magnesia,  &;c.,  are  less  injurious,  but  these  possess  the  notable  in- 
convenience of  adding  to  the  gastric  disorder.  Saline  purgatives, 
such  as  sulphate  of  soda  and  magnesia,  irritate  the  mucous  membrane 
of  the  alimentary  canal,  which  is  generally  very  easily  affected  in 
these  cases.  Aloetic  purgatives  have,  in  addition  to  this,  the  great 
objection  that  they  act  chiefly  on  the  lower  intestines,  especially  the 
rectum. 

I  have  formerly  stated  that  active  purges  may  excite  pollutions  in 
persons  previously  free  from  them,  from  the  facility  with  which  spas- 
modic contractions  of  the  rectum  extend  to  the  seminal  vesicles  ;  and 
I  have  shown  that  pollutions  brought  on  in  this  way  may  continue 
after  the  action  of  the  exciting  cause  has  passed  away,  so  that  a 
serious  case  of  spermatorrhoea  may  remain,  the  progress  of  which 
afterwards  becomes  independent.  It  is,  therefore,  evident  enough 
that  the  abuse  of  purgatives  may  seriously  increase  previously  exist- 
ing involuntary  discharges,  which  were  more  the  cause  than  the 
effect  of  the  constipation. 

On  the  other  hand,  most  of  these  patients  are  in  the  constant  habit 
of  swallowing  purgatives,  not  only  because  they  are  obstinately  cos- 
tive, but  also  because,  from  the  remotest  records  of  medical  science, 
it  has  been  laid  down  as  a  rule  that  hypochondriacs  cannot  be  too 
much  purged — most  persons  affected  with  spermatorrhoea,  as  I  have 
before  said,  being  more  or  less  hypochondriacal.  The  profession 
cannot,  therefore,  be  too  much  on  their  guard  against  yielding  to  the 
solicitations  of  such  patients,  who,  perhaps,  only  complain,  or  com- 
plain chiefly,  of  constipation. 


'  The  power  of  the  douche  bath  in  relieving  constipation,  has  been  very  generally 
overlooked  in  this  country.  Ascending  douches  directed  against  the  anus  seem,  from 
the  experience  I  have  at  present  had  of  their  use,  likely  to  be  a  very  valuable  remedy 
in  cases  of  deficient  action  of  the  colon  and  rectum.  The  temperature  of  the  douche 
should  be  from  80°  to  90°  Fah.,  and  it  should  be  continued  about  ten  minutes.  The 
direction  of  the  spout  may  be  varied,  and  the  water  thrown  on  the  abdominal  parietes, 
with  very  good  effect.     [H.  J.  McD.] 


POLLUTIONS    FROil    RELAXATION    AND    DEBILITY.      809 


CHAPTER  XIV. 


TREATMENT  OF   SPERMATORRHOEA. 


Pollutions  caused  hy  Relaxation  and  Debility. 

Involuntary  seminal  discharges  arising  from  general  atony  and 
following  serious  acute  diseases  are  very  rare.  The  same  indica- 
tions are  presented  as  in  other  prolonged  convalescences.  To  the 
general  means  proper  to  restore  the  strength  may,  however,  be  added 
such  special  ones  as  act  chiefly  on  the  genital  system ;  such  are  Spa 
water  mixed  with  generous  wines,  most  of  the  gum  resins,  canella 
bark,  highly  seasoned  dishes,  game,  &c. 

Pollutions  are  much  too  frequently  attributed  to  debility  of  the 
genital  organs  ;  nevertheless  in  certain  cases  such  local  atony  may 
either  originate  or  keep  up  spermatorrhoea,  which  then  frequently 
yields  to  the  simple  administration  of  general  or  special  tonics. 
Debility  may  continue  also  after  other  causes  have  ceased  to  operate; 
the  same  indication  is  to  be  fulfilled  when  this  is  the  case. 

This  simple  atonic  condition  is  to  be  suspected  when  there  are  no 
symptoms  of  local  irritation — especially  in  such  as  have  suffered 
during  infancy  from  incontinence  of  urine,  in  those  whose  genital 
organs  are  not  perfectly  developed,  or  whose  temperaments  are 
markedly  lymphatic.  When  the  scrotum  is  pendulous  and  cedema- 
tous,  and  the  veins  of  the  spermatic  cords  are  varicose,  with  the 
glans  penis  pale  at  its  orifice,  and  urethral  canal  little  sensitive  to 
catheterism,  there  can  be  no  doubt  of  the  presence  of  atony. 

The  effects  produced  by  atmospheric  changes  give  us  important 
information  on  this  head.  We  may  be  convinced  that  pollutions 
arise  from  atony  when  they  are  increased  during  mild  and  damp 
weather,  while,  on  the  other  hand,  they  decrease  during  dry  winds, 
with  sharp  cold.  These  opposite  effects  show  clearly  enough  that 
tonics  are  indicated. 

Galvanism  may  be  employed  very  advantageously  in  torpidity  of 
the  genital  organs  ;  the  shocks  should  especially  be  passed  between 
the  loins  and  pubes  and  afterwards  between  the  loins  and  perineum. 
After  each  sitting  the  patients  experience  a  feeling  of  strength  and 
warmth  in  the  pelvis,  which  constantly  increases  ;  the  bladder  and 
rectum  contract  more  energetically,  and  the  constipation  ceases.  It 
20 


810  TREATMENT    OF    SPERMATOERHCEA. 

is  evident  enough  that  galvanism  would  be  injurious  in  cases  where 
there  is  the  least  irritation. 

Cantharides  are  constantly  ordered  by  charlatans  in  cases  of  im- 
potence. I  have  never  met  with  a  single  patient  who  did  not  regret 
this  treatment,  and  suifer  from  it.  The  remedy  is  one  which  should 
never  be  administered  to  persons  suffering  from  spermatorrhoea. 

Phosphorus,  which  has  been  recommended  in  these  cases,  falls 
under  the  same  denunciation. 

The  ergot  of  rye  has  recently  been  recommended  in  cases  of  sper- 
matorrhoea, and  from  experiments  I  have  instituted,  I  am  inclined 
to  think  that  it  will  prove  of  much  service  in  pollutions  arising  from 
atony.  The  dose  should  be  from  four  to  twenty  grains,  night  and 
morning,  and  the  best  method  of  administration  is  by  suspending 
the  freshly  powdered  ergot  in  a  glass  of  water. 

Cold,  fresh,  and  salt  water  bathing  have  been  so  generally  recom- 
mended in  cases  of  involuntary  seminal  discharges,  that  I  feel  it 
necessary  to  insist  strongly  against  their  indiscriminate  employment. 
Bad  results  arise  from  them  when  there  is  either  great  constitutional 
debility,  or  too  great  susceptibility  of  the  genital  organs.  Of  these 
different  classes  of  patients,  the  one  is  compelled  to  give  up  bathing 
because  sufficient  reaction  does  not  take  place,  and  the  other  be- 
cause the  involuntary  discharges  are  considerably  increased.  The 
abstraction  of  heat  can  never  directly  augment  animal  strength  and 
activity.  The  tonic  effect  resulting  from  cold  bathing  is,  therefore, 
due  to  the  vigorous  reaction  that  follows,  and  it  is  the  duty  of  the 
medical  man  to  consider  the  constitution  of  each  individual  in  order 
that  the  bath  may  be  employed  with  the  most  suitable  effect  in  each 
particular  case.  My  experience  has  taught  me  that  the  ordinary 
mode  of  cold  bathing  is  chiefly  useful  in  cases  of  masturbation,  or  of 
venereal  excesses  ;  in  these  cases,  too,  the  exercise  of  swimming  may 
be  advantageously  added.  Cold  bathing  is  also  useful  in  recent  cases 
of  nocturnal  pollution,  but  care  must  be  taken,  provided  debility 
have  made  even  slight  progress,  not  to  permit  more  than  sudden 
immersion  into  the  water ;  and  even  this  must  be  left  off  when 
reaction  is  slow  in  taking  place.  When  diurnal  pollutions  have 
commenced  I  consider  cold  bathing  highly  injurious.  If  it  be  neces- 
sary to  stimulate  the  cutaneous  surface  in  such  cases,  other  and 
more  direct  means  must  be  had  recourse  to.  We  may,  for  instance, 
employ  warm  aromatic  baths — especially  in  patients  who  suffered 
from  incontinence  of  urine  during  childhood. 

In  all  cases  care  should  be  taken  to  employ  active  friction  on  the 
skin  when  the  patients  leave  the  bath ;  after  which  flannel  should  be 
immediately  put  on. 

In  some  cases,  cold  applications,  or  lotions  to  the  genital  organs, 
are  borne  when  general  bathing  would  be  injurious,  on  account  of 
the  amount  of  heat  abstracted  from  the  large  surface  exposed.  Ana- 
logous but  more  powerful  effects  are  produced  by  friction  with  ice, 
&Q.,  applied  over  the  same  parts;  or  a  small  quantity  of  pounded  ice, 


POLLUTIONS    FROM    RELAXATION"    AND    DEBILITY.      311 

inclosed  in  a  bladder,  may  be  allowed  to  melt  on  the  loins,  or  pe- 
rineum. These  means  have  been  especially  recommended  before 
going  to  bed,  for  patients  who  suffer  from  nocturnal  pollutions : 
their  effects,  however,  often  exceed  what  is  required,  and  at  best  are 
very  uncertain ;  sometimes,  too,  disagreeable  irritation  of  the  urinary 
organs  follows. 

Cold  douches  on  the  lumbar  and  sacral  regions  are  more  certain 
in  their  action,  on  account  of  the  shock  produced.  I  have  frequently 
employed  these  douches  with  success — extending  their  application 
to  the  perineum.  They  have  appeared  still  more  useful  when  alter- 
nated with  sulphuretted  waters  employed  as  hot  as  possible  in  the 
same  manner.  Reaction  is  much  more  rapidly  established  after 
these  means. 

The  first  application  of  the  douches  should  not  exceed  five 
minutes  in  duration.  The  skin  will  be  found  very  red,  and  a  feel- 
ing of  heat  and  vigor  in  the  parts  will  take  place,  even  before  this 
short  douching  is  ended :  a  very  powerful  tonic  result  may  be  ex- 
pected as  regards  the  genital  organs,  and  for  this  reason  the  duration 
and  force  of  the  douches  must  only  be  increased  after  carefully  watch- 
ing their  effects  for  several  days.  After  this,  if  not  contraindicated, 
the  number  and  duration  of  the  cold  douches  may  be  increased. 

I  have  seen  these  alternated  douches  produce  a  state  of  priapism, 
even  in  persons  who  were  perfectly  impotent  on  the  previous  day. 
The  medical  attendant  must,  therefore,  be  cautious  during  their  em- 
ployment that  he  does  not  over  stimulate  his  patient. 

Cold  drinks  are  generally  useful  and  seldom  injurious  in  these 
cases.  They  take  the  place  of  spirits,  &c.,  from  which  the  patients 
are  generally  obliged  rigorously  to  abstain.  Ice  and  iced  drinks 
have  of  course  the  most  powerful  action,  but  are  not  proper  in  all  cases. 
"When  the  stomach  is  very  irritable  the  use  of  ice  soon  causes  pain 
and  tenderness  of  the  epigastrium,  with  heat  of  skin,  red  tongue,  and 
quick  pulse — indeed,  all  the  symptoms  of  more  or  less  severe  gas- 
tritis. In  other  cases,  again,  the  use  of  ice  causes  troublesome  erec- 
tions followed  by  weight  in  the  prostate  and  frequent  discharge  of 
urine,  sometimes  with  diminution  of  the  stream,  and  redness  at  the 
orifice  of  the  glans  penis;  sometimes,  too,  mucous  discharge  from  the 
urethra  is  set  up,  and  even  vesical  catarrh  has  occurred  in  more  than 
one  case  in  my  practice.  It  is  evident,  therefore,  that  in  order  to 
use  ice,  or  iced  drinks  with  success,  the  digestive  and  genito-urinary 
organs  must  not  be  in  an  irritable  state.  The  season  of  the  year  too 
must  be  considered ;  in  summer  reaction  is  rapid,  and  the  heat 
abstracted  by  the  use  of  ice  is  soon  compensated ;  in  winter,  on  the 
contrary,  there  is  a  constant  struggle  on  the  part  of  the  system  to 
maintain  the  animal  heat,  and  it  is  evident  that  the  administration 
of  substances  calculated  to  abstract  heat  must  be  injurious. 

In  the  internal  administration  of  ice,  we  may  without  inconvenience 
consult  the  taste  of  the  patient.  A  spoonful  may  be  given  several 
times  a  day,  pounded  with  sugar,  or  little  portions  of  ice  may  be 


312  TEEATMENT    OF    SPERMATORRHOEA. 

sucked ;  the  common  ices  of  the  pastry-cooks  maj  be  used,  or  better 
still,  iced  milk  may  be  administered.  In  all  cases  it  is  proper  to 
begin  by,  small  quantities  at  a  time,  and  the  action  of  the  remedy 
must  be  carefully  watched. 

Ferruginous  waters  have  been  very  generally  recommended  in 
cases  of  debility  of  the  genital  organs.  Such  debility,  however,  when 
ret^arded  as  the  sole  cause  of  involuntary  discharges,  is  very  rare  :  or 
at  least  it  rarely  exists  alone  ;  and  hence  it  happens  that  waters 
containing  iron  so  frequently  fail,  although  in  a  few  cases  they  pro- 
duce remarkable  eifects.  In  these  cases,  too,  attention  to  the  state 
of  the  digestive  organs  is  necessary. 

Of  the  natural  ferruginous  waters,  that  of  Spa  is  the  most  em- 
ployed. Of  all  mineral  waters,  however,  those  containing  the  oxide 
of  iron  are  the  most  common,  besides  which  they  are  easily  manu- 
factured artificially,  and  the  artificial  waters  are  quite  as  good  as 
the  natural — indeed,  in  some  cases  they  are  better,  because  a  larger 
quantity  of  carbonic  acid  may  be  forced  into  them.  Some  of  the 
natural  mineral  springs  are  sufficiently  warm  to  be  used  as  baths, 
and  this  is  a  very  useful  mode  of  administration  when  the  stomach 
of  the  patient  is  irritable. 

Spa  water  may  be  taken  in  cases  of  atony,  mixed  with  wine  at 
meals,  and  with  milk,  or  sugar  and  water,  during  the  rest  of  the 
day.  It  is  probably  the  best  and  most  agreeable  mode  of  adminis- 
tering iron ;  but  the  common  forge  water  may  be  substituted  for  it 
without  inconvenience,  or  better  still,  a  solution  of  lactate  of  iron. 
Indeed,  all  ferruginous  preparation  may  be  used  in  atonic  cases, 
care  being  taken  at  the  same  time  to  regulate  the  bowels,  and  to 
watch  the  general  effects  of  the  remedy. 

Tonic  or  astringent  bitters  may  also  be  employed  in  cases  of  sper- 
matorrhoea decidedly  depending  on  an  atonic  condition  of  the 
genital  organs,  and  may  sometimes  be  advantageously  combined  with 
preparations  of  iron.  These  remedies  have  one  great  inconvenience, 
viz.,  their  tendency  to  bring  on  constipation. 

Numerous  general  and  special  excitants  are  contained  in  the 
materia  medica.  Almost  all  the  labiate  and  umbelliferous  plants 
possess  high  stimulating  properties,  and  they  have  accordingly  been 
strongly  recommended  in  cases  of  impotence — which,  it  will  be  re- 
membered, was  formerly  always  supposed  to  arise  from  atony  of  the 
ejaculatory  ducts.  From  my  experience,  however,  even  when  in- 
voluntary seminal  discharges  are  caused  by  debility  of  the  sper- 
matic Organs,  excitants  are  more  frequently  injurious  than  useful. 

The  oleo-resins,  such  as  copaiba,  turpentine,  &c.,  are  more  useful 
in  cases  of  debility,  accompanied  with  abnormal  sensibility  of  the 
_^enito-urinary  mucous  membrane.  These  remedies  should  be  com- 
menced in  small  doses,  which  should  be  increased  very  slowly.  But 
notwithstanding  these  precautions,  the  oleo-resins  often  disorder  the 
digestive  organs,  and  prove  repugnant  to  many  patients,  of  these 
remedies,  copaiba  is,  perhaps,  to  be  preferred.     It  may  be  given 


POLLUTIONS  DEPENDING  ON  NERVOUS  SUSCEPTIBILITY.   313 

mixed  with  magnesia,  or  in  gelatine  capsules,  one  only  of  which  at 
first  should  be  taken  at  bedtime,  increasing  the  dose  according  to  the 
effects  observed.  Tar  water  too  may  be  given  in  doses  of  one  or 
two  tablespoonfuls  mixed  with  water,  three  or  four  times  a  day. 

Nervous  Susceptihility. — There  are  certain  cases  of  involuntary 
seminal  discharges  which  seem  to  arise  from  the  action  of  the  nerves 
of  the  genital  organs,  rather  than  from  debility,  or  irritation.  This 
disposition,  however  rare,  merits  particular  mention,  because  it  pre- 
sents special  indications.  The  genital  organs  sometimes  possess  such 
a  high  degree  of  susceptibility,  that  the  least  touch  produces  extra- 
ordinary sensations  in  them.  Very  slight  friction  suffices  to  cause 
incomplete  erections  with  seminal  emissions.  Catheterism  gives 
intolerable  pain,  even  at  the  orifice  of  the  urethra,  although  there  is 
no  redness  perceptible ;  painful  dragging  sensations  are  felt  in  the 
testicles  and  spermatic  cords,  as  well  as  along  the  penis  ;  darting 
pains,  with  pulsation  and  sense  of  spasmodic  contraction  come  on 
frequently  without  evident  cause,  in  the  perineum  towards  the  neck 
of  the  bladder — fJrobably  in  the  semi^ial  vesicles,  because  involuntary 
emissions  often  result  without  erection,  or  lascivious  ideas,  and  not- 
withstanding efforts  made  to  prevent  them.  These  phenomena  are 
especially  observed  in  irritable  individuals,  who  have  shown  from 
infancy  a  degree  of  morbid  sensibility,  and  whose  first  seminal  dis- 
charges were  caused  by  unnatural  excitement — especially  by  irrita- 
bility of  temper,  or  lively  emotions.  In  such  patients  spermatorrhoea 
becomes  much  aggravated  in  stormy  weather :  cold  baths,  applica- 
tions of  ice,  (fee,  are  injurious,  and  tonics,  internally  administered, 
do  not  succeed  better  in  these  cases.  Sedatives  and  narcotics  may 
be  employed  with  the  best  effects;  preparations  of  opium  should  be 
commenced  in  very  small  doses,  however,  on  account  of  the  tendency 
to  headache,  and  the  nausea  they  produce,  as  well  as  their  increasing 
the  patients'  constipation.  I  have  more  than  once  seen  such  patients 
experience  all  the  bad  effects  of  an  overdose  of  opium  from  the  exhi- 
bition of  an  enema,  consisting  of  a  decoction  made  from  a  sincrle 
poppy-head. 

It  might  be  supposed  that  camphor  would  be  especially  useful  in 
these  cases,  on  account  of  its  particular  action  on  the  nervous  system. 
I  have  rarely  obtained  good  effects  from  it,  however,  and  such  of  my 
patients  of  this  particular  class  who  took  it  in  large  doses,  experi- 
enced nausea,  headache,  and  very  painful  agitation  ;  in  some  even  an 
increased  seminal  discharge  took  place.  Nevertheless,  camphor 
generally  diminishes  erections  arising  from  a  state  of  irritation  ;  un- 
fortunately its  effects  are  very  uncertain,  and  hitherto  no  rules  have 
been  laid  down  by  which  to  predicate  its  action.  On  one  point, 
however,  I  am  satisfied  ;  it  is,  that  camphor  should  never  be  given 
in  large  doses  to  these  patients,  as  bad  effects  are  almost  invariably 
produced.  I  generally  recommend  five  or  six  grains  only  at  first  in 
the  course  of  the  day. 

Counter-irritation  on  the  perineum  and  thighs  may  be  sometimes 


314:  TREATMENT    OP    SPERMATORRHCEA. 

advantageously  employed  to  relieve  the  spasmodic  contractions  that 
cause  diurnal  pollutions  ;  but  the  use  of  cantharides  for  this  purpose 
must  be  avoided. 

The  introduction  of  a  catheter  into  the  bladder  possesses  the 
advantage  of  putting  a  stop  at  once  to  the  nervous  phenomena  of 
which  the  genital  organs  are  the  seat,  and  also  of  lessening  the  in- 
creased sensibility  of  the  urethral  mucous  membrane.  A  moderate- 
sized  gum-elastic  catheter  should  be  at  first  employed  ;  the  introduc- 
tion should  be  performed  slowly,  stopping  from  time  to  time,  both  to 
allow  the  pain  to  pass  off  and  to  get  rid  of  the  spasm  of  the  passage. 
This  spasm  frequently  lasts  more  than  a  minute,  and  during  this  time 
all  attempts  at  passing  the  instrument  on  must  be  absolutely  ab- 
stained from.  Some  patients  suffer  such  pain  during  the  passage  of 
the  instrument,  that  the  whole  body  becomes  agitated,  and  covered 
by  cold  sweat,  and  it  is  precisely  in  these  cases  that  the  catheter 
produces  the  most  marked  and  lasting  effects  ;  when  the  suffering  is 
very  acute,  however,  we  should  not  persist  in  reaching  the  bladder 
the  first  time  of  using  an  instrujjaent. 

At  first  the  instrument  should  not  be  retained  more  than  an  hour, 
and  in  many  cases  it  is  necessary  to  withdraw  it  earlier  ;  at  all  events, 
it  should  always  be  removed  as  soon  as  its  presence  excites  new 
spasms.  It  is  remarkable,  that  notwithstanding  the  severe  pain  caused 
by  its  introduction,  the  patients  invariably  experience  a  sense  of 
comfort  immediately  after  its  removal  ;  this  is  owing  to  the  relief  of 
the  painful  sensations  which  they  previously  felt  in  tlie  genital  organs 
— sensations  which  were  by  no  means  acute,  but  very  disagreeable 
on  account  of  the  constant  anxiety  they  caused. 

The  effects  of  the  first  introduction  must  be  completely  allowed  to 
pass  off  before  having  recourse  to  the  instrument  a  second  time;  a 
day  or  two  should  even  be  allowed  to  elapse  after  the  passage  of 
urine  has  ceased  to  be  painful,  before  again  using  the  catheter. 
Generally  from  five  to  ten  days  would  be  a  proper  interval,  varying 
with  the  peculiarities  of  the  case.  And  now  the  period  of  removing 
the  catheter  may  be  left  to  the  discretion  of  the  patient,  silways 
advising  him  to  retain  it  as  long  as  possible,  or  until  very  violent 
spasms  commence — which  happens  generally  in  these  cases  in  from 
one  to  two  hours. 

The  swelling  which  follows  the  introduction  of  the  catheter  ne- 
cessarily extends  to  the  orifices  of  the  ejaculatory  ducts,  and  thus 
lessens  the  disposition  to  diurnal  pollutions.  The  disordered  nerv- 
ous action  is  also  modified  by  the  presence  of  the  instrument,  and 
the  sensibility  of  the  urethra  returns  by  degrees  to  its  normal  condi- 
tion. The  catheter  does  not  simply  dull,  by  its  continued  presence, 
the  morbid  sensibility  of  the  part;  it  produces  at  first  momentary 
excitement,  accompanied  by  swelling,  and  followed  by  a  permanent 
tonic  effect.  Hence  the  introduction  of  the  instrument  may  be 
advantageously  applied  in  cases  of  atony. 

Some  patients,  however,  are  so  excitable,  that  they  cannot  bring 


POLLUTIONS  DEPENDING   ON  NEEVOUS  SUSCEPTIBILITY.   315 

themselves  to  submit  to  the  pain  caused  by  passing  the  catheter ; 
others  again,  are  unwilling  to  await  the  tardy  results  that  follow  this 
plan  of  treatment,  which  is  necessarily  lingering,  on  account  of  the 
time  required  to  elapse  between  each  introduction  of  the  instrument. 
In  these  cases,  therefore,  other  means  must  be  had  recourse  to. 

Acupuncture  acts  with  much  promptitude  and  energy  on  the  nerves 
of  the  perineum  and  neighboring  parts.  It  should  be  performed  in 
the  following  manner  : — 

The  needles  should  be  as  fine  as  possible,  and  long  enough  to  pene- 
trate nearly  into  the  bladder ;  they  should  be  tempered  by  heating 
until  they  change  color,  so  that  there  may  be  no  danger  of  their 
breaking,  and  a  large  head  of  sealing-wax  should  be  formed  for  them, 
so  that  they  may  be  easily  managed  ;  a  little  oily  matter  should  be 
rubbed  over  them  before  using. 

After  having  caused  the  patient  to  make  water,  the  first  of  these 
needles  is  to  pass  through  the  raphe  of  the  perineum,  midway  be- 
tween the  root  of  the  scrotum  and  the  margin  of  the  anus;  the  point 
must  be  kept  in  the  direction  of  the  median  line,  so  as  to  traverse 
the  inferior  lobe  of  the  prostate,  nearly  as  far  as  the  neck  of  the 
bladder.  The  second  is  next  to  be  introduced  between  the  first  and 
the  margin  of  the  anus,  its  point  being  directed  in  the  same  manner; 
and  the  third  may  be  inserted  in  front  of  the  first,  the  point  being 
directed  obliquely  towards  the  lower  part  of  the  neck  of  the  bladrler. 
By  this  means  the  prostate  would  be  traversed  in  the  course  taken 
by  the  ejaculatory  ducts  in  their  course  to  meet  at  the  verumonta- 
num.  It  is  difficult,  therefore,  for  the  ducts  to  escape  being  acted 
on  by  the  needles,  even  supposing  they  should  not  be  actually  punc- 
tured. 

I  allow  the  needles  to  remain  at  least  one  hour,  and  at  most  three; 
they  may  be  retained  longer,  however,  for  the  only  inconvenience 
they  occasion  arises  from  their  requiring  perfect  immobility.  The 
extraction  is  generally  painful. 

The  patients  experience,  immediately  after  the  removal  of  the 
needles,  a  sense  of  comfort  and  suppleness,  which  extends  from  the 
perineum  to  the  neighboring  parts,  and  probably  depends  on  the  dis- 
appearance of  the  painful  sensations  previously  suffered  ;  and  re- 
markable improvement  in  all  the  phenomena  caused  by  disordered 
innervation  in  the  genital  organs  usually  results  ;  sometimes,  indeed, 
such  disorders  do  not  reappear. 

The  influence  exercised  by  acupuncture  over  the  involuntary  dis- 
charges, is  by  no  means  so  constant.  These  seldom  yield  completely 
after  the  disappearance  of  the  nervous  symptoms,  although  I  have 
seen  a  few  cases  in  which  the  pollutions  ceased  after  a  single  appli- 
cation. 

I  have  also  several  times  used  acupuncture  of  the  spermatic  cord, 
and  even  of  the  testicle,  with  advantage  in  cases  of  neuralgia  in 
these  parts,  taking  care  to  pass  the  needles  between  the  epididymis 
and  body  of  the  testicle.     In  one  case  the  pain  ceased  after  four 


316  TREATMENT    OF    SPERMATOERHCEA. 

repetitions  of  the  operation,  and  I  have  since  learned  that  the  patient 
married  a  few  months  after  leaving  the  hospital.  Neuralgia  of  the 
spermatic  cords  and  testicles  is  not  always  accompanied  with  sper- 
matorrhoea ;  but,  as  may  be  supposed,  the  disorders  are  very  fre- 
quently connected.  In  all  these  cases,  the  first  indication  to  be 
fulfilled  is  the  same. 

Acupuncture  has  unfortunately  lately  fallen  into  disrepute;  at  one 
time  it  was  sadly  abused,  being  recommended  in  all  classics  of  local 
pain,  whatever  its  nature  or  cause  :  hence  the  present  neglect  into 
which  it  has  fallen.  Of  course  discrimination  is  required  in  its  use  ; 
but  in  cases  of  spermatorrhoea  arising  entirely  from  nervous  disorder 
(which  indeed  are  not  common),  its  effects  are  as  prompt  and  durable 
as  beneficial. 

Pollutions  arising  from  Hahit. — To  the  cases  I  have  just  been 
considering  as  suitable  for  acupuncture,  must  be  added  those  in 
which  pollutions  are  kept  up  by  habit.  Not  only  must  these  cases 
be  referred  to  the  influence  of  the  nervous  system,  but  similar  means 
of  treatment  are  applicable  in  both.  I  have  obtained  good  effects 
from  catheterism  and  acupuncture,  in  patients  whose  genital  organs 
were  not  very  excitable,  but  in  whom  the  disorder  was  of  very  long 
standing,  or  arose  from  old  and  long-continued  abuse  or  venereal  ex- 
cesses. 

It  is  very  probable  that  the  spasms  of  the  seminal  vesicles  were 
kept  up  in  these  cases  by  the  influence  exercised  on  all  organs,  and 
particularly  on  those  of  generation,  by  the  periodical  repetition  of 
the  same  acts. 

Catheterism  and  acupuncture  should,  therefore,  be  employed  in 
these  cases,  when  there  is  no  more  evident  indication  to  fulfil. 

Pollutions  caused  by  Sleeping  on  the  Back. — There  is  still  another 
phenomenon  which  appears  to  me  to  arise  from  nervous  influence, 
I  mean  the  effect  produced  by  heat  of  the  loins  during  sleep. 
Amongst  such  as  are  affected  with  nocturnal  pollutions,  the  greater 
number  only  suffer  from  these  accidents  when  lying  on  the  back. 
These  cases  are  not  generally  very  serious,  and  they  may  be  relieved 
by  the  following  simple  means : — 

The  bed  should  be  very  hard,  and  a  piece  of  leather  or  oiled  silk 
should  be  placed  between  the  blanket  and  sheet.  If  this  do  not 
succeed,  it  will  be  proper  to  apply  a  sheet  of  lead  over  the  loins,  and, 
better  still,  to  adapt  to  the  centre  of  this  sheet  a  perpendicular  piece 
of  light  wood,  so  that  the  body  never  can  remaiu  on  the  back  how- 
ever sound  the  sleep  may  be.  The  sheet  of  lead  may  be  fixed  to  a 
linen  girdle  and  tied  in  front ;  and  it  is  evident,  that  for  the  patient 
to  lie  on  his  back,  he  must  rest  equally  balanced  on  the  edge  of  the 
wood  fixed  to  the  centre  of  the  leaden  plate.  The  use  of  lead  pre- 
vents the  loins  from  being  overheated  by  the  presence  of  the  appa- 
ratus, which  might  happen  if  some  metallic  substance  were  not  used. 

I  have  always  found  this  simple  apparatus  successful  in  nocturnal 
pollutions  caused  by  heat  of  the  loins  during  sleep. 


POLLUTIONS    CAUSED    BY   lERITATION.  317 


CHAPTER  Xy. 

TREATMENT  OF  SP  ERM  ATORRHCE  A. 

Pollutions  caused  hy  Irritation  or  Chronic  Inflammation. 

In  by  far  the  greater  number  of  cases,  the  involuntary  seminal 
discharges  are  kept  up  by  a  state  of  irritation  of  the  spermatic  organs; 
and  this  irritation  may  present  various  degrees  of  severity,  varying 
from  simple  excitement  to  well  marked  inflammatory  action.  Noc- 
turnal pollutions  brought  on  by  simple  excitement  of  the  genital 
organs,  are  not  in  general  either  lasting  or  serious  ;  these  discharges, 
therefore,  as  I  have  before  stated,  only  merit  attention  on  account 
of  their  tendency  to  become  habitual. 

Irritation  of  the  genital  organs  generally  shows  itself  by  more  or 
less  vivid  redness  at  the  extremity  of  the  glans  penis,  by  abundant 
secretion  and  frequent  discharge  of  urine,  by  acute  sensibility  in  the 
prostatic  portion  of  the  urethra,  and  by  a  sense  of  weight  and  dis- 
comfort in  the  perineum  and  rectum. 

In  chronic  inflammation  the  prostate  is,  besides,  sensible  to  pressure 
and  perhaps  swollen,  which  may  be  easily  ascertained  by  an  exami- 
nation per  rectum.  The  patients  suffer  from  mucous  urethral  dis- 
charge, generally  the  sequel  of  old  blennorrhagia,  and  which  becomes 
aggravated  from  very* trifling  causes.  The  testicles  are  often  mor- 
bidly sensitive,  painful,  and  perhaps  swollen. 

Spring  is  unfavorable  to  all  patients  whose  involuntary  discharges 
arise  from  hypersthenia  ;  dry  and  cold  weather  is  equally  injurious  ; 
in  general  they  feel  better  in  warm  damp  seasons.  Cold  lotions, 
cold  bathing,  tonics,  and  excitants,  are  all  equally  hurtful.  Moment- 
ary benefit  may,  however,  occasionally  arise  from  these  means,  and 
this  happens  because  debility  generally  accompanies  the  irritation 
of  chronic  inflammation  ;  but  such  momentary  benefit  is  rapidly  fol- 
lowed by  marked  increase  of  the  bad  symptoms.  It  is  often  diffi- 
cult to  distinguish  chronic  inflammation  from  irritation,  and  the 
indications  to  be  fulfilled  are  the  same  in  both  states,  therefore  I 
shall  consider  their  treatment  together. 

Hippocrates  recommended  that  at  first  the  whale  surface  of  the 
body  should  be  fomented,  that  lavements  should  be  given,  and  after 
a  time  tepid  baths  used.  The  moderns,  on  the  other  hand,  have  with 
one  accord  recommended  cold  bathing  in  all  cases  of  spermatorrhoea, 
and  this  has  arisen  from  their  constantly  and  falsely  attributing  the 


318  TREATMENT    OF    SPERMATORRHCEA. 

disorder  to  atony  of  the  genital  organs.  The  temperature  of  the  bath 
should  be  that  most  pleasant  to  the  feelings  of  the  patient:  too  high  a 
temperature  causes  agitation  ;  too  low,  on  the  other  hand,  increases 
instead  of  relieving,  local  irritation.  Emollient  baths,  containing 
vegetable  decoctions,  are  indicated  when  the  skin  is  dry,  irritable,  or 
covered  with  eruptions ;  but  with  the  exception  of  these  cases,  they  are 
not  more  useful  than  baths  of  plain  water.  The  advice  of  Hippo- 
crates relative  to  the  diet  and  general  regimen  of  such  patients, 
harmonizes  with  the  employment  of  these  emollient  means.  After 
having  prepared  the  stomach  by  a  mild  emetic,  he  recommends  skim 
milk  as  a  beverage,  ass's  milk,  and  during  forty  days  cow's  milk. 
"  So  long  as  this  milk  diet  shall  continue,"  he  adds,  "administer 
barley  water  in  the  evening,  and  forbid  all  solid  food  ;  afterwards 
give  soft  food  in  small  quantities  at  first,  and  fatten  the  patient  as 
much  as  possible."  This  fluid  regimen  is  certainly  the  fittest  to 
assist  the  baths,  fomentations,  &o.,  in  calming  the  irritation  of  the 
genital  organs,  by  favoring  abundant  secretion  of  unstimuluting 
urine.  It  has  also  the  advantage  of  furnishing  the  digestive  organs 
with  nutriment  suited  to  their  weakened  powers. 

The  stomach  must  not  be  over  fatigued  with  the  use  of  milk,  how- 
ever, and  in  order  to  prevent  this,  di9"erent  means  may  be  employed. 
At  first  new  milk  may  be  given,  as  soon  as  possible  after  it  has  been 
drawn,  and  this  may  be  varied  by  changing  from  goat's  milk  to 
ass's  milk,  and  from  the  milk  of  cows  to  that  of  sheep.  Afterwards 
the  milk  may  be  boiled,  or  given  cold,  or  iced  ;  sugar  may  be  added 
to  it,  or  jam,  water  and  sugar.  If  acid  eructations  follow  its  use,  a 
few  grains  of  magnesia  may  be  mixed  with  it,  or  two  or  three  spoon- 
fuls of  Spa-water,  or,  better  still,  of  lime-water.  A  few  drops  of 
rum  may  be  added  to  it  to  give  flavor,  or  a  laurel  leaf,  or  a  sprig  of 
fennel  may  be  allowed  to  infuse  in  it  while  it  cools.  Tea  and  cofl"ee 
must  not  be  given  with  the  milk,  on  account  of  their  injurious  action 
on  the  nervous  system,  but  chocolate  may  be  used  in  small  quantities. 
The  stomach  is  generally  so  capricious  in  these  cases,  that  a  milk 
diet  could  not  be  long  submitted  to  unless  it  were  constantly  modi- 
fied. As,  therefore,  it  is  the  most  suitable  diet  in  severe  cases,  care 
must  be  taken  to  vary  it  frequently. 

The  soft  food,  recommended  by  Hippocrates  to  follow  milk  diet, 
should  consist  of  decoctions  made  from  barley,  beans,  &c.,  or  of  the 
dried  juices  of  feculent  vegetables.  Of  all  feculent  roots  the  potato 
is  the  best  suited  to  follow  the  use  of  strict  milk  diet  in  these  cases. 
The  most  simple  mode  of  its  preparation  is  the  best.  The  potato 
is  easily  digested,  and  besides,  it  modifies  the  secretion  of  urine. 
Strawberries  possess  a  similar  property,  and  very  soon  relieve  irrita- 
tion of  the  bladder  and  urethra.  There  are  some  patients  whose 
urine  is  quite  transparent,  but  who  nevertheless  cannot  retain  it  long  ; 
thej  sufi"er  from  pain  and  heat  in  the  neck  of  the  bladder  and  pros- 
tate, together  with  darting  pains  in  the  same  region,  but  without  any 
symptoms  indicative  of  inflammation.     This  particular  kind  of  irritu- 


CAUTERIZATION.  319 

tion  is  difficult  to  relieve  by  pharmaceutical  means,  but  it  often  yields 
readily  enough  to  the  abundant  use  of  strawberries ;  raspberries  and 
cherries  produce  somewhat  similar,  but  much  less  active  effects. 

The  advice  given  by  Hippocrates,  "  to  fatten  the  patient  as  much 
as  possible,"  is  by  no  means  opposed  to  the  diet  I  have  recom- 
mended, for  it  is  well  known,  that  matters  containing  sugar  and  fe- 
cula  in  abundance,  favor  the  formation  of  fat. 

Hippocrates  adds,  that  wine  should  be  abstained  from  during  a 
year,  and  I  have  frequently  had  opportunities  of  remarking  the 
wisdom  of  this  advice.  Many  patients,  indeed,  grow  abstemious  as 
the  result  of  their  own  experience.  The  prohibition  of  wine  should 
include  all  other  fermented  liquors,  as  well  as  tea  and  coffee — indeed, 
all  exciting  drinks.  But  there  are  cases  of  spermatorrhoea,  arising 
from  irritation,  in  which  wine  may  be  allowed,  and  in  these  cases  it 
may  be  advantageously  taken  iced,  or  mixed  with  an  alkaline,  or 
carbonated  water. 

In  cases  of  well  established  spermatorrhoea,  all  excitement  of  the 
genital  organs  increases  the  pollutions  ;  the  patients  must,  there- 
fore, not  only  abstain  from  coitus,  but  from  everything  which  may 
excite  venereal  desires,  or  lascivious  ideas.  Still,  however,  when 
convalescence  is  advancing,  very  moderate  sexual  intercourse  is  ne- 
cessary to  relieve  the  overfilled  seminal  vesicles,  and  to  prevent 
them  from  again  falling  into  a  habit  of  involuntary  contraction. 

Fatigue  is  hurtful  to  patients  whose  pollutions  arise  from  irrita- 
tion, but  moderate  exercise  is  beneficial.  Excessive  mental  exertion 
is  also  to  be  avoided.  In  the  milder  cases  of  involuntary  discharge, 
caused  by  irritation,  the  introduction  of  a  catheter  may  be  sufficient, 
as  in  cases  of  morbid  sensibility,  to  modify  the  condition  of  the  mu- 
cous membrane.^  The  remedy  in  the  severer  cases  I  have  still  to 
consider,  I  mean  cauterization  of  the  mucous  membrane  of  the  pro- 
static portion  of  the  urethra,  by  means  of  the  nitrate  of  silver. 

Cauterization. — This  operation  is  especially  indicated  in  cases  of 
chronic  inflammation,  or  irritation  of  the  urethra  :  its  results  may 
be  considered  certain  when  involuntary  discharges  follow  a  common 
clap,  or  non-contagious  gleet.  I  have  also  found  it  successful  in 
many  cases  where  atony  or  relaxation  seemed  to  predominate,  and 
in  a  few  cases  of  marked  nervous  disorder,  and  congenital  predis- 
position. In  the  latter  cases,  however,  the  benefit  derived  from 
cauterization  has  seldom  proved  permanent,  though  I  believe  that 
bv  changino;  the  condition  of  the  tissues,  the  foundation  has  been 
laid  for  the  successful  use  of  other  means. 

Before  proceeding  to  cauterization  it  is  indispensably  necessary  to 
introduce  a  catheter,  for  the  double  purpose  of  taking  the  exact  length 
of  the  urethra,  and  of  completely  emptying  the  bladder.  On  slowly 
withdrawing  the  instrument,  during  the  escape  of  urine,  the  stream  is 

1  I  have  successfully  treated  a  mild  case  in  this  manner.     [II.  J.  M'D.] 


320  TEEATMENT    OF    SPERMATOKRHCEA. 

arrested  as  soon  as  the  eyes  of  the  catheter  enter  the  canal,  and  re- 
commences when  they  are  again  pushed  into  the  bladder.  The  penis 
being  then  moderately  stretched,  the  thumb  and  forefinger  should  be 
applied  to  the  instrument  at  the  point  of  the  glans.  When  the  cathe- 
ter is  withdrawn,  the  distance  between  the  finger  and  thumb  and  its 
eyes,  gives  the  exact  length  of  the  urethra,  and  this  must  be  imme- 
diately marked  on  the  porte-caustique,  the  eyes  of  the  catheter  being 
applied  to  its  olivary  extremity,  and  the  position  of  the  fingers  indi- 
cated by  fixing  a  little  slider  on  the  stem  of  the  instrument.  When 
the  porte-caustique  has  penetrated  so  far  into  the  urethra,  that  this 
slider  touches  the  point  of  the  glans — the  penis  being  exactly  in  the 
same  state  of  elongation  in  which  it  was  when  the  catheter  was  in- 
troduced— it  is  clear  that  its  olivary  extremity  will  be  in  precisely 
the  spot  previously  occupied  by  the  eyes  of  the  catheter,  when  the 
length  of  the  canal  was  taken ;  that  is  to  say,  at  the  commencement 
of  the  neck  of  the  bladder — a  position  which  it  is  highly  important 
to  the  operator  to  be  assured  of. 

The  bladder  must  be  completely  emptied,  in  order  that  no  urine 
may  penetrate  into  the  tube  of  the  porte-caustique,  and  that  none 
may  enter  the  urethra  during  cauterization.  When  the  caustic  is 
wetted  by  the  urine,  it  acts  much  less  energetically  than  if  it  were 
dry,  and  its  action  extends  to  parts  where  it  was  not  required.  The 
inflammation  set  up  may,  under  these  circumstances,  be  insufficient 
to  fulfil  the  desired  object,  although,  at  the  same  time,  extremely 
painful  on  account  of  its  extent. 

I  need  not  describe  the  instrument  I  use  for  the  purpose  of  cauter- 
izing the  urethra,  as  it  is  pretty  well  known  to  the  profession.  I 
must,  however,  point  out  a  few  of  the  faults  of  those  sold,  by  even 
the  best  instrument  makers,  as  my  instrument.  The  enlargement 
terminating  the  cuvette,  is  generally  too  round  and  too  small.  It 
closes  the  end  of  the  tube  like  a  stopper,  and  hence  it  often  happens 
that  the  mucous  membrane  forcibly  embracing  the  cuvette  during 
cauterization,  becomes  pinched  on  closing  the  instrument,  and  per- 
haps portions  of  the  membrane  may  be  torn  away  on  withdrawing  it. 
By  giving  the  extremity  of  the  instrument  greater  volume,  and  an 
elongated  olivary  form,  this  accident  is  rendered  quite  impossible. 

The  diameter  of  this  olivary  body  should  considerably  exceed  that 
of  the  tube  of  the  instrument,  because,  although  the  operator  may 
judge  when  he  is  near  the  neck  of  the  bladder,  by  the  nearness  of 
the  slider  on  the  stem  of  the  instrument  to  the  point  of  the  glans, 
still  it  is  proper  that  he  should  have  a  distinct  sensation  when  the 
neck  of  the  bladder  is  reached.  The  passage  of  the  enlarged  ex- 
tremity of  the  instrument  through  the  sphincter  of  the  bladder  gives 
this  sensation  very  distinctly;  then  on  gently  withdrawing  the  in- 
strument, a  slight  resistance  is  felt  to  the  re-entrance  of  the  bulb 
into  the  urethra,  and  the  operator  may  be  certain  that  the  cuvette 
containing  the  caustic  is  in  its  proper  position. 

The  cuvette  and  the  stem  which  supports  it,  should  be  formed  of  a 


i 


CAUTERIZATION.  321 

single  piece  of  metal,  because  any  soldering  is  soon  destroyed  by  the 
caustic.  It  is  not,  however,  indispensable  that  the  cuvette  should  be 
made  of  platinum.  I  have  used  the  same  silver  instrument  for  several 
years,  -without  its  being  worn  by  the  action  of  the  caustic. 

Very  often  the  cavity  in  the  cuvette  intended  to  hold  the  caustic  is 
carefully  polished ;  when  this  is  done,  the  caustic  does  not  adhere 
firmly  to  its  sides,  and  there  is  danger  of  its  escaping.  The  inner 
surface  of  this  cavity  should,  on  the  contrary,  be  as  rough  as  possible. 

The  nitrate  of  silver  must  be  melted  into  the  cuvette  by  means  of 
a  spirit  lamp,  so  that  it  may  present,  when  cold,  a  smooth  and  even 
surface.  So  long  as  it  continues  rough,  so  as  to  project  beyond  the 
level  of  the  sides  of  the  cuvette,  the  projecting  portions  are  apt  to  be 
broken  oflf  in  closing  the  instrument,  and  to  fall  out  when  it  is  again 
opened. 

The  patient  should  lie  down  during  cauterization  ;  either  standing 
or  sitting  he  is  less  fixed,  and  is  more  apt  to  move  his  pelvis  suddenly 
— an  inconvenience  which  it  is  important  to  avoid  ;  the  operator,  too, 
is  less  at  his  ease,  and  less  certain  as  to  his  proceedings. 

As  the  olivary  extremity  of  the  instrument  approaches  the  neck  of 
the  bladder,  the  irritability  of  the  passage  increases,  and  the  patient's 
agitation  often  becomes  so  great  as  to  inconvenience  the  operator. 
The  instrument  should  now  be  allowed  to  pass  on  by  its  own  gravity, 
attention  being  paid  to  detect  the  moment  when  the  olivary  body 
passes  the  neck  of  the  bladder :  as  soon  as  this  happens,  the  instru- 
ment should  be  gently  withdrawn — so  as  to  bring  its  olivary  extremity 
slightly  within  the  neck  of  the  bladder — and  firmly  held  in  that  situa- 
tion, while  the  outer  tube  is  a  little  drawn  back,  and  the  cuvette  very 
rapidly  passed  over  the  inferior  surface  of  the  prostate,  by  slightly 
turning  the  stem  attached  to  it;  the  instrument  should  then  be  in- 
stantly closed  and  slowly  withdrawn  from  the  urethra. 

In  this  manner  the  nitrate  of  silver  reaches  the  prostate  quite  dry 
in  the  situation  where  the  ejaculatory  ducts  open.  Their  orifices 
must,  therefore,  be  cauterized  sufficiently  to  produce  a  considerable 
modification  in  the  state  of  the  tissues.  No  other  parts  are  touched; 
and  hence  the  inflammation  set  up  is  at  once  both  acute  and  cir- 
cumscribed. 

It  must  be  remembered  that  cauterization  is  practised  in  these 
cases,  in  order  to  bring  on  a  lasting  change  in  the  condition  of  the 
tissues,  by  means  of  active  inflammation,  and  not  for  the  purpose  of 
causing  loss  of  substance  ;  and  hence  it  is  not  necessary  to  produce 
a  slough.  The  action  of  the  nitrate  of  silver  should  be  just  as  rapid 
as  in  cauterizing  the  conjunctiva  in  chronic  inflammation,  ulceration 
of  the  cornea,  &c.  There  is  the  same  intention  in  both  these  diff'er- 
ent  cases,  and  the  result  obtained  is  of  the  same  nature. 

It  is  now  twenty  years  since  I  first  commenced  the  practice  of  cau- 
terizing the  prostate  in  cases  of  ancient  gleet,  which  had  resisted  all 
other  kinds  of  treatment ;  very  soon  afterwards,  I  applied  the  same 
powerful  means  to  the  treatment  of  involuntary  seminal  discharges. 


322  TEEATMENT    OF    SPERMATOKRHCEA. 

Since  that  time  I  have  performed  the  operation  almost  daily,  and  I 
have  never  seen,  in  my  own  practice,  any  of  the  violent  eifects,  such 
as  retention  of  urine,  hemorrhage,  long-continued  violent  pain,  nar- 
rowing of  the  passage,  &c.,  described  by  some  operators  as  super- 
vening. Indeed,  I  should  almost  doubt  the  accuracy  of  these  de- 
scriptions, had  I  not  been  consulted  in  one  or  two  cases  in  which  the 
symptoms  had  been  set  up.  Such  ill  effects  result  from  the  injurious 
and  absurd  practice  of  some  surgeons  of  cauterizing  the  urethra 
during  a  fixed  period  of  time,  watch  in  hand.  The  time  required  to 
glance  at  the  second  hand  is  more  than  sufiicient  for  appl3?ing  the 
caustic. 

During  the  first  days  subsequent  to  cauterization,  baths,  enemata, 
and  diluents  should  be  prescribed,  with  milk  and  vegetable  diet,  so 
as  to  dilute  the  urine  as  much  as  possible.  All  fatigue  should  be 
abstained  from,  and  exposure  to  cold  rigorously  avoided.  For  two 
or  three  days  micturition  is  frequent,  painful,  and  accompanied  with 
the  escape  of  a  few  drops  of  blood.  But  these  symptoms  soon  pass 
off,  provided  no  imprudence  be  committed,  I  have,  however,  known 
the  pain  continue  ten  days  or  more,  in  patients  who  committed  errors 
of  diet,  or  fatigued  themselves  too  early,  or  who  exposed  themselves 
to  cold  or  damp. 

These  imprudences  are  not  only  injurious  by  hindering  the  rapid 
termination  of  the  inflammatory  process  ;  they  may  also  compromise 
its  results,  which  depend  principally  on  the  facility  with  which  reso- 
lution takes  place.  So  long  as  the  inflammatory  stage  continues,  the 
involuntary  discharges  are  increased  rather  than  diminished  in  fre- 
quency, and  sensible  improvement  only  appears  when  resolution 
takes  place.  It  is  seldom  that  we  can  judge  of  the  amount  of  benefit 
derived  until  the  twelfth  or  fifteenth  day,  or  sometimes  longer,  espe- 
cially if  a  return  of  the  inflammation  should  take  place,  when  perhaps 
the  patient  thinks  himself  freed  from  all  restraint.  He  must  be  espe- 
cially warned  against  indulging  his  sexual  desires,  although  energetic 
erections  are  sure  to  occur.  Some  unreflecting  practitioners  have 
had  recourse  to  a  second  cauterization,  immediately  that  the  severe 
inflammatory  symptoms  of  the  first  are  dissipated,  and  sometimes 
have  performed  the  operation  five  or  six  times  following,  expecting 
that  the  involuntary  discharges  would  be  arrested  by  such  means. 
Indeed,  I  have  seen  several  patients  who  had  been  cauterized  every 
eight  days,  or  even  oftener,  for  a  month  or  two,  without  other  results 
than  obstinate  irritation  and  stabbing  pain  in  the  neck  of  the  blad- 
der, with  contraction  of  the  urethra. 

It  must  be  remembered,  that  it  is  wholly  for  the  consecutive  re- 
sults that  cauterization  is  performed,  and  that  these  results  depend 
on  a  change  which  takes  place  in  the  condition  of  the  tissues.  The 
curative  action  can,  therefore,  only  show  itself  after  the  complete 
resolution  of  the  acute  inflammation  set  up  by  the  nitrate  of  silver. 
This  seldom  takes  place  until  the  eighth  day,  and  as  many  more 
days  are  necessary  before  the  required  change  is  effected.     I  have 


CAUTEKIZATION".  323 

seen  patients  in  whom  a  month  and  more  has  been  required,  because 
the  inflammation  was  prolonged  by  accidental  causes.  In  such  pa- 
tients improvement  commenced  late,  its  progress  was  slow,  and  the 
cure  was  not  perfect  until  six  weeks  or  two  months  after  the  opera- 
tion. 

In  no  case  can  we  expect  to  find  the  curative  effects  of  cauteriza- 
tion manifested  earlier  than  a  fortnight  at  soonest,  and  a  month  must 
be  allowed  to  elapse  before  judging  of  them  definitely.  It  is,  there- 
fore, absurd  to  attempt  to  set  up,  a  second  time,  the  inflammatory 
process,  before  the  first  has  had  opportunity  to  produce  its  effects. 
When  cauterization  is  about  to  effect  a  cure,  it  soon  becomes  evident 
by  the  rapid  diminution  of  the  involuntary  discharges,  and  the  steady 
progress  of  the  convalescence.  It  is  sufficient  afterwards  to  remove 
the  circumstances  that  might  occasion  a  relapse,  and  all  the  functions 
will  soon  be  re-established.  Exercise  should  be  increased  with  the 
return  of  strength,  in  order  to  confirm  the  recovery. 

One  operation  suffices  in  such  a  case;  indeed,  the  operation  should 
not  be  repeated,  even  although  the  patient,  in  hope  of  accelerating 
his  recovery,  may  be  anxious  for  it.  Hygienic  care,  travelling,  and 
sulphuretted  waters  will  do  the  rest.  A  second  cauterization  should 
only  be  practised  when  accidental  causes  have  prevented  the  first 
from  producing  its  effects,  and  when  a  second  application  of  the 
caustic  fails  to  complete  the  cure,  it  is  probable  that  a  third  will  have 
no  better  success ;  other  means,  therefore,  should  be  had  recourse  to. 

When  cauterization  only  gives  momentary  relief  too,  it  should 
not  be  repeated,  for  a  second  and  third  would  have  no  better 
chances  of  success  than  the  first.  Further  investigation  into  the 
causes  that  keep  up  the  pollutions,  must  be  undertaken.  Very 
often,  causes  previously  unsuspected  are  discovered,  the  proper 
treatment  for  which,  of  course,  must  be  employed. 

In  conclusion,  I  may  simply  record  my  opinion,  that  two-thirds  of 
the  cases  of  spermatorrhoea  would  be  beyond  the  reach  of  medical 
assistance,  were  it  not  for  the  beneficial  effects  produced  by  the  ap- 
plication of  nitrate  of  silver  to  the  prostatic  portion  of  the  urethra. 

Action  of  the  Nitrate  of  Silver. — There  is  scarcely  a  tyro  in  surgery 
who  has  not  seen  the  nitrate  of  silver  in  substance,  applied  to  fun- 
gous, irritable,  and  bleeding  ulcers  ;  and  all  well  know,  that  the 
pain  caused  by  the  application  soon  ceases;  that  the  granulations 
assume  a  more  healthy  aspect,  and  that  the  discharge  becomes  more 
creamy  and  the  sore  shows  a  disposition  to  heal.  It  is  not  by  de- 
stroying the  fungous  and  bleeding  surface  that  this  improvement  is 
effected,  but  by  giving  tone  to  the  vessels  of  the  part.  In  affections 
of  the  skin,  the  nitrate  also  renders  much  service  ;  but  it  is  in  chronic 
ophthalmia  perhaps,  that  the  rapidity  of  its  effects  is  especially  seen. 
Before  cauterization,  the  conjunctival  mucous  membrane  is  injected, 
painful,  thickened,  fungoid,  sometimes  rough  and  granular.  The 
follicles  of  the  lids  furnish  an  abundant  secretion  of  matter,  and  the 
secretion  of  the  lachrymal  glands  is  much  increased,  and  their  pro- 


324  TEEATMENT    OF    SPERM ATOERHCEA. 

ducts  modified,  so  that  the  discharge  of  tears  over  the  cheek  fre- 
quently causes  ulceration. 

Immediately  after  the  application  of  the  nitrate  of  silver  these 
symptoms  are  exasperated;  the  tears  especially,  flow  in  much  greater 
abundance.  But  soon  the  pain  lessens,  and  the  lachrymal  discharge 
becomes  arrested  ;  on  the  following  day  the  injection  of  the  eyes 
becomes  less  evident,  and  for  several  days  resolution  continues  its 
progress,  leaving  the  conjunctiva  much  paler  than  it  was  before. 

The  same  results  take  place  in  ulcerations  of  the  cornea. 

In  these  cases,  the  nitrate  of  silver  is  merely  drawn  lightly  and 
rapidly  over  the  diseased  surface,  its  action  not  being  sufficiently 
continued  to  produce  a  slough. 

Precisely  the  same  phenomena  occur  in  the  prostatic  portion  of 
the  urethra,  the  action  of  the  nitrate  of  silver  being  of  limited  dura- 
tion. 

In  leucorrhoea  too,  which  frequently  depends  on  ulceration  of  the 
neck  of  the  uterus,  cauterization  with  the  nitrate  of  silver  possesses 
undoubted  advantages  over  all  other  modes  of  treatment.  The  neck 
of  the  uterus  is  red,  fungoid,  swollen,  and  more  acutely  sensitive 
than  natural ;  there  are  often  excoriations  varying  in  extent,  the 
surfaces  of  which,  when  wiped  with  lint,  generally  bleed. 

In  leucorrhoea  which  owes  its  origin  to  a  chronic  inflammation, 
sui  generis^  of  the  lining  of  the  vagina,  attended  by  insupportable 
pruritus,  and  accompanied  with  abundant  thick,  acrid,  yellow  dis- 
charge, the  nitrate  of  silver  is  often  of  much  service.  The  mucous 
membrane  is  not  only  red  and  injected,  but  frequently  also,  rough 
and  granular,  and  while  general  means  are  at  the  same  time  employed, 
the  application  of  the  caustic  affords  a  very  speedy  mode  of  relief 
from  many  of  the  more  distressing  symptoms. 

In  cases  of  leucorrhoea  too,  which  depend  on  lymphatic  scrofulous 
habit — in  atonic  cases  in  fact — the  nitrate  of  silver  will  often  arrest 
the  discharge,  and  thus  remove  a  very  serious  cause  of  debilty,  while 
other  means  aVe  taken  for  the  permanent  improvement  of  the  system 
generally. 

Chronic  Vesical  Catarrli. — During  more  than  fifteen  years  I  have 
employed  cauterization  with  much  success  in  cases  of  chronic  inflam- 
mation of  the  bladder.  At  first,  like  many  other  practitioners,  I 
dreaded  the  effects  of  such  an  agent  on  the  mucous  membrane,  con- 
stantly bathed  by  the  urine,  and  I  was  frequently  prevented  from 
having  recourse  to  it  by  the  terrible  obstinacy  of  the  disease.  Since 
that  time,  however,  I  have  found  cauterization  cure  nine-tenths  of  the 
vesical  catarrhs  that  have  come  under  my  care,  many  of  which,  too, 
had  resisted  various  scientific  treatment  for  years.  The  cases  which 
cauterization  failed  in  curing  completely  were  much  improved  by  it. 
Cauterization  should,  however,  only  be  used  in  uncomplicated  cases  : 
where  there  is  suspicion  of  suppuration  in  the  kidnej^s,  or  of  abscess 
in   the  prostate,  opening  into  the  bladder,  this  treatment  is  contra- 


CAUTERIZATION.  325 

indicated.  Generally  a  single  cauterization  suffices,  but  I  have  oc- 
casionally been  obliged  to  repeat  the  operation  three  or  four  times. 

The  bladder  should  be  emptied  as  completely  as  possible,  and  the 
same  instrument  should  be  used  as  in  cauterizing  the  prostate,  except 
that  it  should  be  furnished  with  a  convex  cuvette.  It  is  sufficient  to 
pass  the  caustic  rapidly  to  the  right  and  to  the  left,  once  only,  to  ob- 
tain the  desired  result ;  it  is  better  to  be  obliged  to  repeat  the  opera- 
tion than  to  excite  too  much  inflammation. 

After  the  operation,  frequent  baths  must  be  used,  with  emollient 
enemata,  abundant  diluents  and  rest.  The  inflammation  passes  off 
very  rapidly,  and  I  have  not  met  with  one  case  in  thirty,  in  which 
abstraction  of  blood  has  been  necessary. 

When  cauterization  does  not  succeed  in  perfecting  the  cure,  it  in- 
variably so  alters  the  condition  of  the  mucous  membrane  that  the 
means  previously  employed  unsuccessfully  may  be  used  with  every 
prospect  of  success — I  refer  to  the  natural  and  artificial  sulphuretted 
waters,  tar-water,  and  the  turpentines — especially  copaiba. 

Deviation  of  the  Orifices  of  the  Ejaculatory  Canals. — I  have  stated 
that  cauterization  should  be  very  rapid,  and  confined  to  the  surface  of 
the  prostate,  in  spermatorrhoea  arising  from  irritation.  There  are, 
however,  cases  in  which  involuntary  discharges  are  complicated  with 
deviation  of  the  orifices  of  the  ejaculatory  canals,  and  this  deviation 
requires  a  slight  alteration  in  the  mode  of  operating.  It  is  no  longer 
necessary  simply  to  modify  the  condition  of  the  raucous  membrane; 
it  is  required  to  bring  forward  the  verumontanura,  which  is  turned 
backwards.  For  this  purpose  it  is  necessary  to  produce  a  very  small 
slough  in  front  of  the  orifices.  Instead  of  the  ordinary  cuvette  of  the 
porte-caustique,  therefore,  the  instrument  should  be  solid  ;  but  about 
fourteen  lines  from  its  olivary  extremity,  there  should  be  a  little  ex- 
cavation about  large  enough  to  hold  a  grain  of  linseed.  This  is  to  be 
filled  with  the  nitrate  of  silver  in  the  same  manner  as  before ;  and 
when  the  olivary  extremity  of  the  instrument  is  situated  at  the  neck 
of  the  bladder,  the  tube  is  to  be  drawn  back,  and  the  caustic  al- 
lowed to  dissolve  entirely,  in  front  of  the  verumontanura.  A  little 
slough  results,  and  the  cicatrix  that  succeeds  it  is  generally  sufficient 
to  draw  forwards  the  orifices  of  the  ejaculatory  ducts. 


SI 


326  TREATMENT    OF    SPERMATOREHCEA. 


CHAPTER  XVI. 


TREATMENT    OF    S  P  E  RM  A  T  0  R  R  H  (E  A. 


Convalescence. 

In  recent  and  simple  cases  of  involuntary  seminal  discliarges, 
re-establishment  takes  place  promptly  and  rapidly;  all  the  organs 
successively  resume  their  normal  functions,  without  requiring  any 
further  treatment  on  the  part  of  the  surgeon.  But  after  severe 
cases  the  progress  from  disease  to  health  is  never  so  simple  or 
rapid.  The  constitution,  having  been  seriously  weakened,  requires 
much  time  and  attention  for  its  repair.  Beside  this,  habit,  which 
possesses  considerable  influence  over  all  organs,  tends  unceasingly 
to  cause  a  relapse  in  cases  of  spermatorrhoea  that  have  been  of  long 
duration.  It  is,  therefore,  slowly  and  with  prudence  that  the  patient 
should  return  to  his  ordinary  diet  and  mode  of  life  ;  and  there  are 
certain  hygienic  precautions  which  in  some  cases  must  be  continued 
long  after  the  perfect  re-establishment  of  health. 

In  proportion  as  the  energy  of  the  digestive  organs  returns, 
more  nourishing  food  is  required,  and  the  patients  can  no  longer 
bear  the  strict  diet  which  was  highly  beneficial  at  first.  The  pa- 
tients are  also  impelled  by  the  desire  of  increasing  their  strength  ; 
but  for  this  purpose  it  is  better  to  permit  an  increased  quantity  of 
light  food,  with  greater  frequency  of  meals,  than  to  allow,  too  early, 
a  return  to  heavy  diet  that  maj^  disorder  the  digestive  organs,  and 
thus  endanger  a  relapse.  From  vegetable  diet,  the  patient  should 
proceed  to  fish  and  white  meats,  before  having  recourse  to  more 
stimulating  food. 

Of  course,  exception  must  be  made  here,  of  those  patients  who 
are  troubled  with  ascarides,  and  in  whom  tonic  and  stimulating  diet 
is  required  on  account  of  their  pollutions  arising  from  atony. 

During  convalescence  from  spermatorrhoea,  arising  from  irritation, 
a  warm  and  damp  climate  agrees  best,  but  on  the  other  hand,  when 


CONVALESCENCE.  327 

the  disorder  arises  from  atony  or  from  lymphatic  constitution,  a  dry 
and  pure  air  is  required. 

When  the  strength  is  so  far  re-established  that  the  eifects  of 
cold  are  no  longer  to  be  dreaded,  cold  bathing  is  very  useful  pro- 
vided the  season  be  favorable :  when  reaction  takes  place  vigor- 
ously, the  loss  of  the  economy  caused  by  it  diminishes  the  secretion 
of  semen.  At  first  the  bath  should  consist  of  one  plunge  only,  and 
if  the  atmospheric  temperature  be  low,  two  or  three  days  should  be 
permitted  to  elapse  between  the  baths.  The  length  of  time  the  pa- 
tient continues  in  the  water,  should  be  very  gradually  and  carefully 
increased. 

Exercise  should  be  taken  in  proportion  to  the  return  of  strength, 
not  only  to  increase  the  strength,  but  also  in  order  that  the  products 
of  digestion  may  be  as  much  as  possible  employed  in  the  repair  of 
waste.  This  is  the  best  means  to  prevent  such  materials  from 
proving  an  undue  stimulus  to  the  spermatic  organs.  Travelling  is 
highly  useful  after  spermatorrhoea  has  been  cured ;  but  in  order  that 
the  best  results  should  be  derived  from  it,  the  patient  should  travel 
on  foot.  Carriage  exercise  favors  constipation,  and  excites  the  geni- 
tal organs,  and  horse  exercise  possesses  both  these  inconveniences 
in  a  still  higher  decree. 

I  have  more  than  once  stated  that  the  seminal  secretion  is 
never  completely  arrested  in  man  except  after  long  and  severe  ill- 
nesses. The  pollutions  will  therefore  return,  provided  absolute  con- 
tinence be  persevered  in.  Such  pollutions  may  occur  so  rarely  as 
not  to  exert  any  injurious  influence  on  the  health  ;  but  they  may 
increase  by  simple  habit,  or  by  the  action  of  irresistible  accidental 
circumstances.  In  order  that  involuntary  seminal  discharges,  there- 
fore, should  cease  entirely,  it  becomes  necessary  that  they  should  be 
replaced  by  normal  voluntary  emissions.  The  regular  exercise  of 
the  organs,  too,  can  alone  restore  to  them  their  proper  energy.  This 
is  the  case  with  all  the  organs  of  the  body,  and  the  generative  are 
by  no  means  an  exception  to  the  general  rule.  In  order,  there- 
fore, that  the  return  to  health  may  be  durable,  regular  sexual  intex'- 
course  must  be  established.  The  question  now  arises :  when  ought 
such  intercourse  to  be  permitted  ?  The  answer  is :  when  continued 
continence  has  become  so  painful  as  to  bring  on  actual  fatigue  of 
the  generative  organs,  and  when  no  further  progress  is  observed  in 
the  development  of  their  energy.  There  is  then  danger  that  the 
organs  may  lose  power  and  fall  into  a  state  of  debility  from  too  long 
inaction. 

The  surgeon  is  now  consulted  by  the  patient  and  his  friends  as 
to  the  propriety  of  his  marrying ;  and  this  is  one  of  the  most 
difficult  questions  to  decide.  Marriage  ought  not  to  be  contracted 
until  the  fullest  proofs  of  a  perfect  and  permanent  return  to  health 
has  been  given.  The  responsibility  of  sacrificing  the  happiness 
of  the  female  is  to  be  considered  seriously,  as  well  as  the  possibility 


328  TEEATMENT    OF    SPERMATOREHGEA. 

of  a  relapse  occurring  to  the  patient,  from  comparatively  unre- 
strained indulgence  during  the  first  months  of  marriage.  _  On  this 
subject,  however,  I  think  that  no  decided  rules  can  be  laid  down  ; 
the  matter  must  be  left  to  the  judgment  of  the  surgeon,  after  he 
has  carefully  considered  all  the  circumstances  affecting  each  par- 
ticular case. 


THE  END. 


ON    DISEASES 


OF  THE 


VESICULiE  SEMINALES: 


THEIE   ASSOCIATED   ORGANS, 


WITH  SPECIAL  KEFEKENCE  TO  THE 


MORBID    SECRETIONS    OF   THE    PROSTATIC   AND 
URETHRAL    MUCOUS    MEMBRANE. 


HARRIS  WILSON,  M.D. 


PEEFACE. 


I 


The  reluctance  shown  by  the  medical  profession  to  enter 
upon  the  consideration  of  the  affections  described  in  the 
following  pages  is  gradually  passing  away;  but  the  effect 
of  the  want  of  attention  to  these  important  subjects  by 
those  qualified  to  undertake  their  examination,  which  has 
hitherto  existed,  is  shown  in  the  meagre  information  with 
regard  to  the  true  nature  and  pathology  of  the  diseases 
which  we  at  present  possess. 

Several  of  the  works  which  have  been  written  on  the 
subject  are  directed  almost  exclusively  to  the  treatment  of 
the  symptoms  of  the  disease,  without  giving  attention  to 
the  condition  of  the  structures  whence  those  symptoms 
proceed,  and  without  considering  the  necessity  of  making 
the  functions  of  the  affected  organs  a  part  of  the  investiga- 
tion of  their  diseases. 

The  ground  which  I  have  selected  has  proved  to  be 
unbroken  in  many  points,  more  particularly  in  that  having 
reference  to  a  system  of  classification.  A  method  of 
arranging  the  various  and  contradictory  symptoms  of  sper- 
matorrhoea has  been  much  wanted,  and  that  w^iioh  I  now 
advance,  if  not  entirely  adopted,  will,  I  hope,  nevertheless, 
lead  to  a  better  understanding  of  the  subject. 

If  my  views  differ  in  some  degree  from  the  observations 
of  others,  it  is  not  that  I  have  any  intention  of  putting 


332  PREFACE. 

forward  special  theories;  but  that  the  facts  and  sugges- 
tions expressed  in  these  pages  have  risen  forcibly  and  con- 
vincingly to  my  mind,  while  contemplating  the  symptoms 
presented  by  individual  cases. 

In  submitting  the  following  pages  to  publication,  I  have 
been  guided  by  the  desire  to  enlarge  our  knowledge  of  the 
different  varieties  of  this  distressing  disease.  AVhether 
that  object  has  been  gained  must  be  left  to  the  judgment  of 
those  into  whose  hands  this  treatise  may  fall,  and  who  may 
feel  inclined  to  interpret  the  phenomena  of  spermatorrhoea 
by  the  illustrations  which  it  contains. 

I  have  thouglit  it  undesirable  to  lengthen  this  work  by 
the  publication  of  the  cases,  from  which  my  opinions  as  to 
the  nature  of  spermatorrhoea  have  been  deduced.  But  at 
some  future  time,  I  may  resolve  to  give  those  cases  to  the 
profession,  either  in  full  or  in  abstract,  founded  on  a  careful 
analysis,  as  may  appear  best  suited  to  convey  information, 
when  the  opportunity  and  inducement  occur. 

55  Upper  Charlotte  Street, 
FiTZROY  Square. 

January^  1856. 


TABLE  OF  CONTENTS. 


CHAPTER  I. 


INTRODUCTORY  REMARKS. 


Relative  dependence  of  the  Pathological  Phenomena — Method  of  examining 

them  ...... 

Plan  proposed  for  investigating  SpermatoiThoea 

Causes  of  the  Disease — Difficulties  of  Cure — Independence  of  Structures  in 

Yolved  ...... 

Importance  of  this  View  of  the  Subject 

Case  in  illustration — Removal  of  one  Testicle — Return  of  the  Malady 

Failure  of  Cauterization — Removal  of  the  other  Testicle 

Issues  in  the  Perineum   ..... 

Operation — Condition  of  Patient  twelve  months  after  Operation 
Conclusions         ...  .... 

Erection  an  evidence  of  the  Pathological  Condition  of  the  Testicle 
Necessity  for  Classification         ..... 


337 
337 

338 
338 
339 
339 
339 
340 
340 
341 
341 


CHAPTER  II. 

COMPOSITION  OF  THE  SEMEN,  FUNCTIONAL,  CHEMICAL,  AND 
MICROSCOPICAL. 


Source  of  the  Component  parts  of  the  Semen    .  . 

Relative  proportions  and  variation  .... 

Chemical  composition      ...... 

Ducts  of  the  Prostate  Gland       ..... 

Composition  and  purposes  of  the  Prostatic  Secretion     . 
Formation  of  Prostatic  Calculi— Composition  of  Secretion  of  the 
Seminales    ....... 

Uses  of  the  Secretion — Improbability  of  supposed  accumulation  of  Scm 

Distinguishing  Characters  of  Vesicular  Mucus 

Fallacy  of  supposed  accumulation  shown  by  comparative  analogy 


VesiculiB 
inal  Fluid 


341 
342 
342 
343 
343 

343 
344 
344 
345 


334 


CONTENTS. 


Function  of  the  Testicles — Limit  of  our  knowledge  relative  to  the  ultimate 

destination  of  the  Semen— Spermatozoa      ..... 
Difficulty  of  discovering  them — Their  resistance  to  destruction 
Their  physical  characters — Nutrition  derived  from  destruction  of  the  Seminal 

Fluid  .  .  •  •  •  ■  • 

Jourdan's  views  on  the  nourishment  of  Human  Parasites  — Henle  and  Wagner's 

observations— Propagation  by  gemmation  ..... 
Donne  on  the  Spermatozoa  of  the  Dormouse — The  Spermatophori 
Koelliker's  observations  on  the  evolution  of  Spermatozoa — Their  liability  to 

destruction — Earlier  stages  of  the  Spermatophori 


345 
345 

346 

346 
347 

347 


CHAPTER  III. 


PATHOLOGY  OF  SPERMATORRHCEA. 

Spermatorrhoea — Signification  of  the  term         .... 
Necessity  for  Classification  of  the  different  manifestations  of  the  disease 

Primary  division      ....... 

Table  of  special  Classification — Independence  of  healthy  individual  existence 

on  venereal  influence  ...... 

Vital  energy  necessary  for  secretion  of  Seminal  Fluid  ... 
Lallemand's  Classification  founded  on  character  of  emissions — Nocturnal  emis 

sions  ........ 

Diurnal  emissions — Proposed  third  division        .... 

Laws  governing  Spermatozoa      ...... 

Sthenic  Spermatorrhoea  of  the  Testicle  ..... 

Asthenic  Spermatorrhoea  of  the  Testicle  .... 

Sthenic  Spermatorrhoea  of  the  Vesiculre  Seminales 

Asthenic  Spermatorrhoea  of  the  Vesiculre  Seminales 

Sthenic  Spermatorrhoea  of  the  Prostate  Gland  .... 

Asthenic  Spermatorrhoea  of  the  Prostate  Gland 
Spermatorrhoea  arising  from  conditions  of  the  Urethra 


348 

348 

349 
349 

349 
350 
350 
350 
351 
351 
352 
353 
354 
354 


CHAPTER  IV 


IM  POTENCY. 

Idiopathic  Impotency  Defined     .......       355 

Incapacity  without  equivalent   diseased   action — Health   independent  of  the 

Function  of  Generation        .......       355 

Impotency  from  imperfect  Organic  Development — Asthenic  Impotency  .       356 

Principle  of  Treatment — Impotency  remotely  dependent  on  the  nervous  system, 

immediately  on  the  character  of  the  Emissions         ....       356 

Imj^otency  from  high  nervous  Structural  Excitement — From  excitement  caus- 
ing Epileptic  Spasm  .  .  .  .  .  .  .       357 


CONTENTS. 


335 


From  Debility — From  too  precipitate  or  too  tardy  Emission 
Impotency  from  conditions  of  the  Urethra  aflfecting  the  Emissions 
Treatment  ....... 


357 
357 
358 


CHAPTER  V. 


CAUSES  OF  SPERMATORRHEA. 


^Necessity  for,  and  difBcuIty  of,  arriving  at  the  true  Causes  of  Spermatorrhoea 
Constitutional  Diseases  which  become  causes — Influence  on  the  Brain   and 

Nervous  System       ....... 

Division  into  three  progressive  stages     ..... 

Indirect  Sources  of  the  Disease — Participation  of  other  Systems  of  the  Body 

Congenital  Debility — The  Urethra  an  occasional  cause  . 

Remote  Causes  existing  in  the  Kidneys  and  Bladder — Irritation  induced  by 

Diet  and  Medicines  ....... 

Venereal  Excesses  .  •  . 

Stricture  of  the  Urethra — The  Prostate  Gland  an  occasional  cause — Influence 

of  the  Contractions  of  the  Rectum  .... 

Condition  of  the  Vesiculte  and  their  Secretion   ... 

Simplest  forms  of  Mechanical  Irritation — Diarrhoea  and  Dysentery 

Position  of  Testicles — Structural  Irritation  of  the  Vesiculse  Seminales 

Vesiculte  Seminales  the  centre  of  diseased  actions 

Self-abuse  and  its  Influences       ...... 

Hufeland's  narration  of  its  evil  effects  ..... 


358 

358 

359 
359 
359 

360 
360 

361 
361 
362 
362 
362 
363 
363 


CHAPTER  YL 


SYMPTOMS  OF  SPERMATORRHCEA. 


Necessity  for  an  exact  knowledge  of  exciting  cause — Symptoms  in  a  patient 

afflicted  with  Spermatorrhoea 
Constitutional  and  Local  Efi"ects 
Effects  on  the  Brain 
Hereditary  tendency  to  Mental  Derangement — Efi"ects  on  the  Heart  and  Circu 

lation  .... 

Effects  on  Digestion 

Peculiarities  of  certain  Local  Symptoms 
Symptom  distinctive  of  A'"esicular  and  Prostatic  Irritation — Progressive  Local 

Symptoms  .... 
Irritation  of  the  Kidneys  and  Bladder  . 
Characters  of  the  Urine  in  a  well-marked  case  of  Spermatorrhoea 


366 
367 
368 

368 
368 
368 

369 
370 
370 


836 


CONTENTS. 


CHAPTER  VII. 


TREATMENT  OF  SPERMATORRHCEA. 


Objections  to  specifics  in  the  Treatment  of  the  Disease — Observation  of  Lalle- 

mand            .........  370 

Plan  of  Treatment  .  .  .  .  .  .  .  .371 

Circumstances  under  wLicli  Cauterization  by  nitrate  of  silver  may  be  useful    .  371 
Lallemand's  opinion  of  the  specific  action  of  caustic — Safer  use  of  the  solution 

•with  equivalent  benefit — Mode  of  application  of  the  solution        .             .  372 
Mode  of  application  of  caustic  important  to  its  success — Introduction  of  the 

Catheter      .........  372 

Application  of  Cold — Cold  as  a  Stimulant          .....  373 

Use  of  Leeches,  and  local  abstraction  of  Blood — Blisters  to  the  Perineum — 

Issue  or  Seton  in  the  Perineum       ......  373 

Use  of  Medicines  internally — Ergot  of  Rye       .....  374 

Camphor — Copaiba — Cantharides          .......  374 

Sedatives  for  relieving  pain — Hyoscyamus — Inunction  of  Veratrine  and  Bella- 
donna          .........  374 

Gallic  Acid  and  Tannin — Acupuncture — Principle  of  Treatment           .             .  375 
Necessity  for  modifying  the  Treatment  of  Constitutional  Effects — Attention  to 

the  circulating  system  necessary     ......  375 

Abstraction  of  Blood — Sensibility  of  the  Digestive  System       .             .             .  375 
Remedial  Indications — Regimen — Cod-liver  oil  ,             .             .             .             .376 

Necessity  for  ascertaining  the  primary  cause  of  the  Disease — Treatment  of 

Onanism       .........  377 

Hufeland's  plan  of  management  in  this  Disorder           ....  378 

Conclusion           .........  380 


ON    SPEEMATOHEHffiA. 


I 


CHAPTER  I. 

IXTRODUCTORT   KEMAEKS. 

In  mentally  weighing  the  relative  dependence  of  the  various 
pathological  phenomena  or  symptoms,  which  attend  upon  a  case 
of  spermatorrhoea,  I  have  found  it  often  diflScult  to  account  satis- 
factorily for  the  opposite  cfmditions  which  presented  themselves 
during  the  progress  of  the  disease.  It  frequently  happened,  that  the 
existing  symptoms  manifested  but  little  proportion  to  the  real  and 
assignable  cause  ;  and  that  the  cause,  when  discovered,  might  not 
unreasonably  be  looked  upon  as  insufficient  for  the  production  of  so 
extensive  and  so  important  a  sequence  of  morbid  symptoms. 

With  the  view,  therefore,  of  being  able  to  comprehend  fully  the 
series  of  unexpected  effects  of  an  ascertained  cause  which  accompany 
this  disease,  I  have  considered  it  expedient  to  examine,  step  by  step, 
the  phenomena  which  present  themselves  during  its  gradual  develop- 
ment ;  such  phenomena  being  proved  to  depend  on  pathological 
alterations  in  the  structures  involved  in  the  production  and  continu- 
ance of -the  disease.  These  effects  are  usually  presented  to  the 
medical  man  only  after  a  certain  duration,  and  when  in  consequence 
of  their  prolonged  continuance  they  may  be  taken  to  have  acquired 
an  existence  separate  from,  and  independent  of,  their  original  and 
primary  cause. 

The  plan  I  propose  to  follow  in  investigating  the  subject  of  sper- 
matorrhoea, is,  to  take  a  short  review  of  the  functions  belonging  to 
the  generative  system ;  to  compare  these  functions  as  they  exist  in 
health  with  their  state  in  disease ;  to  examine  microscopically,  the 
physical  condition  of  the  secreted  fluids  ;  and  to  ascertain  as  far  as 
possible  the  relative  chemical  dependencies  of  the  generative  secre- 
tions. A  rigorous  adherence  to  this  plan  of  weighing  the  observa- 
tions furnished  by  the  disease,  will  lead  us,  by  degrees,  to  a  complete 
understanding  of  the  intricate  web  of  phenomena  by  which  it  is  sur- 
rounded, and  elucidate  with  clearness  its  pathology,  causes,  and 
symptoms.  We  shall  thus  be  prepared  to  enter  upon  the  difBculfc 
field  of  treatment,  with  the  assurance  of  correct  views  as  a  guide  to 
prospective  success. 


838  INTRODUCTORY   REMARKS. 

The  disease  depends  for  its  more  essential  features,  on  the  nature 
of  the  secretion  of  the  generative  organs  ;  the  relative  amount  of  that 
secretion  ;  its  qualities  ;  and  the  state,  whether  of  irritation  or  other- 
wise, of  the  organs  concerned  in  its  production.  We  therefore  per- 
ceive clearly  the  importance  of  the  symptoms  we  have  to  consider 
and  investigate. 

The  cure  of  spermatorrhoea  is  rendered  difficult  in  proportion  to 
the  number  of  the  organs,  or  parts  of  organs,  involved  in  disease. 
Irregularities  of  secretion  of  the  different  organs,  and  excess  in  the 
relative  proportions  of  such  secretions,  constitute  distinct  forms  of 
spermatorrhoea,  irrespective  altogether  of  actual  organic  changes  in 
the  structures  themselves. 

The  semen  in  its  healthy  state  is  a  compound  fluid,  and  its  com- 
ponent parts  bear  a  determinate  proportion  to  each  other.  These 
component  parts  are  collected  from  different  points  to  constitute  a 
mass,  the  varying  qualities  and  bulk  of  which  thus  become  the  evi- 
dence of  the  pathological  conditions  of  the  genital  structures.  Dis- 
eases of  these  structures  do  not  affect  the  general  health  in  a  like 
degree,  because  the  difference  of  thei'r  influence  in  exhausting  the 
vital  power  is  modified  by  the  relative  amount  of  excitement  that 
each  structure  exerts  over  the  nervous  system. 

The  importance  of  considering  the  subject  in  this  way,  struck  me 
forcibly,  while  studying  the  progress  of  spermatorrhoea  in  a  case 
where  the  removal  of  the  most  important  of  the  organs  of  generation 
— the  testicles — failed  in  curing  the  disease.  This  circumstance  first 
led  me  to  the  supposition  of  the  actual  independence  and  separate 
action  of  the  different  portions  of  the  apparatus,  and  the  investiga- 
tions I  have  since  made,  with  the  view  of  elucidating  this  par- 
ticular point,  have  fully  confirmed  me  in  the  opinion.  The  case 
throughout  affords  an  illustration  of  the  views  I  entertain,  and  tak- 
ing it  as  my  text,  the  confusion  of  having  to  refer  to  isolated -portions 
of  several  other  cases  will  be  avoided.  For  this  reason,  therefore, 
independent  of  the  real  interest  attached  to  the  case,  1  hope  to  be 
excused  for  entering  fully  into  its  detail. 

A  gentleman  of  imaginative  and  excitable  temperament,  educated 
for  the  medical  profession,  became  the  victim  of  self- abuse,  brought 
on  by  bad  example  at  school.  The  practice  was  indulged  in  from 
time  to  time  until  the  age  of  twenty,  and  resulted  in  the  pro- 
duction of  a  permanent  and  continuous  discharge  of  seminal  fluid 
from  the  urethra,  attended  with  frequent  spasmodic  emissions. 
While  in  this  state,  he  fell  into  the  hands  of  an  irregular  practi- 
tioner, who,  acting  on  the  empirical  and  mischievous  notion  that 
if  one  drug  did  not  succeed  another  might,  dosed  him  with  every 
possible  kind  of  nostrum.  The  result  of  this  course,  as  might  be 
expected,  was  a  severe  aggravation  of  the  disease.  He  became  the 
patient  successively  of  three  or  four  medical  men,  without  experi- 
encing any  relief,  and  then  placed  himself  under  the  treatment 
of  an  eminent  surgeon,  who  advised  exercise,  to  the  neglect  of  all 


INTEODUCTORY    EEMARKS.  339 

effective  remedial  treatment.  Exercise  as  a  curative  medicine,  proved 
equally  abortive,  with  ill-timed  and  ill-suited  pharmaceutical  reme- 
dies, and  he  again  sought  surgical  aid,  this  time  selecting  a  gentle- 
man of  high  standing  in  the  profession,  who  recommended  marriage 
as  the  only  panacea  left. 

Finding  the  methods  of  treatment  hitherto  suggested  had  inva- 
riably a  tendency  to  aggravate  rather  than  to  relieve  his  symptoms, 
the  idea  of  a  complete  eradication  of  his  disease,  by  the  removal  of 
the  supposed  source  of  the  morbid  phenomena — namely,  the  testi- 
cles— occurred  to  his  mind.  After  a  good  deal  of  persuasion,  he 
induced  Sir  Astley  Cooper  to  undertake  this  operation,  and  the 
left  testicle  was  accordingly  removed.  The  patient  was,  however, 
deceived  in  his  hope,  and  in  a  letter  to  me  he  says,  "  After  the  ces- 
sation of  the  inflammatory  action,  the  disease  did  not  appear  to  be 
in  the  least  altered  by  the  operation." 

Being  disappointed  as  to  the  result  of  this  heroic  method  of  treat- 
ment, he  submitted,  under  another  surgeon,  to  the  hardly  less 
severe  operation  of  cauterization  of  the  urethra  ;  this  was  repeated 
several  times.  The  employment  of  the  caustic  plan  was  not  fol- 
lowed by  any  useful  results,  nor  by  any  alleviation  of  his  symptoms. 

Keeping  his  mind  constantly  directed  to  the  subject,  this  gentle- 
man became  persuaded  in  the  idea,  that  by  sacrificing  the  remain- 
ing testicle,  he  Avould  certainly  be  relieved  from  a  malady  most  irk- 
some to  him,  and  ill-requiting  the  advantages -of  a  questionable 
virility.  Much  opposition  was  oifered  to  this  proposal  by  the  sur- 
geon whom  he  consulted,  but  without  changing  his  determination, 
and  his  urgent  request  was  complied  with,  under  my  observation, 
in  1853.  It  was  imagined  that  this  operation  must  necessarily 
prove  successful,  and  for  a  few  weeks,  during  the  time  that  the 
irritation  occasioned  by  the  wound  remained,  it  appeared  to  be  so. 
After  that  time  the  spermatorrhoea  reappeared,  apparently  with 
the  same  degree  of  activity  as  before ;  erections  and  emissions,  both 
nocturnal  and  diurnal,  returned,  but  the  ejected  fluid  was  evidently 
less  in  quantity,  and  altered  in  its  quality.  The  patient's  health 
now  became  more  impaired  than  it  had  heretofore  been;  he  expe- 
rienced great  debility,  suff'ered  very  much  from  depression  of  spirits, 
and  his  mind  lost  its  capability  of  concentration.  He  also  began 
to  give  up  hope  ;  but  always  fertile  in  imagination,  he  conceived 
the  notion  that  the  true  seat  of  the  disease  must  have  been  mis- 
taken, and  judging  from  certain  sensations  which  he  now  experi- 
enced that  it  was,  to  a  great  extent,  if  not  entirely  referable,  not 
to  the  testicles,  as  he  had  heretofore  imagined,  but  to  the  prostate 
gland. 

On  this  supposition  it  was  proposed  to  establish  one  or  more  issues 
in  the  perineum  ;  a  fold  of  skin,  midway  between  the  anus  and 
commencement  of  the  scrotum,  was  pinched  up,  and  transfixed  by 
a  bistoury,  and  a  piece  of  potassa  fusa  introduced  into  the  wound, 
and  lodged  beneath  the  skin.     The  effect  of  this  proceeding  was 


340  INTKODUCTORY    REMARKS. 

Jlie  formation  of  a  slough,  half  an  inch  square,  and  about  the  same 
in  depth.  The  slough  separated  in  ten  or  twelve  days,  discharged 
freely  for  a  time,  and  in  a  few  weeks  was  completely  healed.  The 
patient  experienced  so  much  benefit  from  this  plan,  that  three 
months  later  he  was  desirous  of  having  the  operation  repeated. 
An  incision  was  made  as  before,  but  rather  deeper,  and  posterior 
to  the  former  on  the  left  side  of  the  raphe.  The  local  effect  was 
more  extensive,  but,  as  in  the  previous  instance,  no  untoward  symp- 
toms resulted.  A  few  weeks  subsequently,  a  similar  issue  was 
made,  to  the  right  of  the  raphe.  The  operations  were  almost  pain- 
less, being  performed  under  the  partial  influence  of  chloroform. 

It  is  now  nearly  twelve  months  since  the  last  issue  was  entirely 
healed,  and  the  condition  of  the  patient  is  thus  far  satisfactory. 
He  has  gained  flesh  and  strength  ;  he  feels  light  and  active;  enjoj^s 
exercise  ;  considers  his  mind  better  qualified  for  occupation  than 
has  been  the  case  for  several  years  past ;  has  recovered  the  color 
of  his  cheeks,  and  presents  altogether  a  fresh  and  healthy  appear- 
ance. He  still  has  .erections  occasionally  in  the  night,  and  some- 
times in  the  morning.  Distinct  emissions  continue  to  take  place, 
but  at  long  intervals,  the  fluid  being  considerably  less  in  quantity, 
thin  and  transparent,  and  presenting  no  admixture  of  the  usual 
milky  secretion  of  the  prostate  gland.  During  the  whole  of  the 
time  subsequent  to  the  formation  of  the  first  issue,  he  has  pursued 
no  medical  treatment,  except  that  requisite  to  prepare  him  for  the 
operations ;  therefore,  to  the  latter  alone  must  be  attributed  his 
improvement. 

This  curious,  and,  in  many  points  of  view,  very  interesting  case, 
furnishes  a  means  of  distinguishing  the  separate  functions  of  the 
generative  organs,  of  studying  the  influence  of  their  morbid  actions 
on  the  general  system,  of  diagnosing  with  a  certain  accuracy  the 
situation  and  degree  of  the  irritation  which  accompanies  the  disease, 
and  the  relative  dependence  oh  each  other  of  the  various  structures 
involved.  Whatever  amount  of  excessive  action  may  have  disturbed 
the  functions  of  the  genital  organs,  was  not  diminished  by  taking 
away  the  supposed  cause,  but  was  rather  concentrated  with  increased 
intensity  in  the  vesiculae  seminales  after  the  removal  of  the  testicles. 
And  the  disease,  instead  of  being  checked,  became,  as  it  were,  per- 
petuated by  the  continuance  of  the  irritation;  the  vesiculse  seminales 
being,  and  becoming  still  more,  a  source  of  derivation  of  the  con- 
tinued and  exhausting  discharges.  Judging  from  the  results  of  the 
removal  of  the  testicles,  it  is  evident,  also,  that  they  could  not  have 
been  the  primary  seat  of  the  disease,  and  that  the  erections  and 
emissions  arose,  not  from  the  presence  of  seminal  fluid  in  them,  but 
from  over  activity  in  the  vesiculte  seminales,  as  is  evidenced  in  the 
return  and  continuance  of  the  disease,  after  the  cessation  of  the 
counter-irritation  following  the  operations. 

Erection  is  shown  by  this  case  to  be,  not  necessarily  the  result 
of  the  presence  of  seminal  fluid  in  the  testicles,  but  to  be  even  in- 


COMPOSITION    OF    THE    SEMEN.  841 

dependent  of  those  oro;nns.  Congestion  of  the  vessels  of  the  penis, 
and  consequent  erection,  may  arise  from  several  different  causes, 
morbid  or  natural,  and  entirely  independent  of  the  functions  of  the 
generative  system.  In  eunuchs  these  phenomena  are  exemplifieil, 
though  the  functional  povrer  of  the  testicles  has  never  been  present. 
Erection,  and  a  kind  of  modified  emission,  take  place  in  them,  in  the 
same  manner  as  in  the  patient  whose  case  I  have  just  narrated. 
Thevesiculse  are  subjected  to  the  spasmodic  contraction  which  ejects 
their  contents  under  the  influence  of  excitement,  and  this,  as  in 
the  normal  condition  of  the  organs,  is  accompanied  by  a  certain 
amount  of  erection  and  sensation.  The  quality  of  virility  is  alone 
lost.  Questions-  might  arise,  to  which  these  known  facts  would 
supply  an  answer  of  considerable  importance  ;  for  example,  that  the 
existence  of  erection  and  emission  is  no  proof  that  a  disease  affecting 
the  testicles  is  not  therefore  of  a  malignant  character. 

It  is  with  a  conviction  of  the  necessity  for  a  more  complete  indi- 
vidualization and  classification  of  the  symptoms  of  spermatorrhoea 
that  I  have  given  my  attention  to  the  elucidation  of  the  subject.  I 
have  endeavored  as  far  as  possible  to  make  out  the  relative  depen- 
dence of  the  numerous  phenomena  exhibited  by  the  symptoms  of 
the  disease,  and  to  show  that  the  mere  cursory  examination  and 
treatment  of  a  few  of  its  prominent  symptoms  will  hardly  be  likely 
to  lead  to  an  alleviation  of  the  disease,  and  will  do  little  towards 
establishing  a  scientific  foundation  for  supporting  a  correct  principle 
of  cure. 


CHAPTER  II. 

COMPOSITION    OF   THE    SEMEN,    FUNCTIONAL,    CHEMICAL,    AND 
MICROSCOPICAL. 

The  seminal  fluid,  or  semen,  when  poured  out  from  the  urethra,  is 
a  semi-opaque,  starch-like,  compound  fluid  ;  sometimes  yellowish,  like 
cream,  and  at  other  times  of  a  greenish-white  tint.  It  is  made  up  of 
the  secretions  of  the  testicles,  vesiculse  seminales,  prostate  gland,  and 
Cowper's  glands,  and  mucus  of  the  urethra,  the  latter  being,  as  a 
component  principle,  merely  accidental ;  floating  in  it  are  also  to  be 
found  a  greater  or  less  number  of  epithelial  scales.  The  chief 
bulk  of  the  seminal  mass  consists  of  transparent  ovoid  bodies,  more 
dense  than  the  fluid  that  surrounds  them.  These  bodies  are  the 
production  of  the  vesiculee  seminales,  receiving  their  form  from  the 
sacculi  of  those  organs,  in  which  they  are  moulded  during  the 
progress  of  gradual  inspissation. 

In  a  healthy  condition  the  secretions  derived  from  these  separate 
organs  bear  a  relative  proportion  to  each  other  ;  that  of  the  vesi- 
cuke  seminales  amounting  to  about  four-sevenths  of  the  whole  ;  that 
of  the  testicles  and  vasa  deferentia  to  about  one-seventh ;  and  the 

99 


312  COMPOSITION    OF    THE    SEMEN. 

remainder  consisting  of  the  products  of  the  prostate  fijland,  Cow- 
per's  glands,  and  mucous  membrane  of  the  urethra.  The  average 
quantity  of  semen  expelled  at  each  emission  is  about  half  an  ounce, 
but  this  quantity,  as  well  as  the  relative  proportions  of  its  compo- 
sition is  not  always  the  same  ;  both  depend  very  much  on  the 
perfection  of  healthy  action  of  the  various  parts  whence  they  are 
derived. 

I  deduce  these  proportions,  not  only  from  the  manifest  differ- 
ences of  quantity  in  the  component  parts  of  the  fluid,  but  also  from 
the  diminution  of  the  secretion  occasioned  by  the  removal  of  the 
testicles,  and  destruction  of  the  other  organs.  The  proportions  are 
liable  to  variation  from  the  circumstance,  that  irritation  mny  arise 
in  one  or  more  of  the  structures  without  affecting  the  others  ;  and 
as  such  irritation  would  cause  an  increased  secretion  of  a  particular 
kind,  it  is  evident  that  the  composition  of  the  fluid  must  undergo  a 
corresponding  alteration.  The  quantity  also  varies  considerably  with 
the  constitution  of  the  individual — in  one  being  abundant,  in  others 
below  the  average,  though  neither  state  is  incompatible  with  vigorous 
health.  In  certain  diseased  states,  also,  there  is  a  largely  increased 
secretion,  depending  simply  upon  irritable  action.  On  the  other 
hand,  there  may  be  a  diminution  of  secretion,  arising  from  an 
atonic  condition  of  the  organs,  and  amounting  to  almost  complete 
suppression. 

The  chemical  composition  of  the  seminal  fluid,  as  ascertained  by 
Vauquelin,  consists,  according  to  his  latest  analysis,  of: — 

Water 90  parts. 

Mucus G     " 

Phosphate  of  lime     ...  3      " 

Phosphate  of  soda    ...  1      " 


100 
When  healthy  semen  is  first  emitted  it  has  a  neutral  reaction, 
which  appears  to  be  due  to  the  presence  of  the  prostatic  fluid,  holding 
in  suspension  and  solution  a  large  quantity  of  the  phosphates  of  lime 
and  soda.  While  the  fluid  continues  warm,  the  salts  are  partially 
retained  in  solution  ;  but  on  cooling,  and  with  slight  concentration, 
crystals  of  the  compound  phosphate  make  their  appearance,  either 
in  the  form  of  long,  transparent,  colorless  prisms,  thick  in  the 
middle,  and  tapering  slightly  to  either  extremity,  or  springing  in 
abundance  from  a  central  point,  and  assuming  the  stellate  form. 
The  milky  appearance  of  the  secretion  arises  from  the  presence  of 
minute  granules,  which  float  about  in  the  fluid  in  vast  numbers,  and 
remain  suspended  in  it  by  virtue  of  its  viscidity.  Tliese  granules 
are  more  or  less  abundant  in  different  states  of  health,  and  rela- 
tively to  the  activity  of  function  of  the  prostate  gland,  and  consist 
of  phosphate  of  lime  without  any  addition  of  the  salt  of  soda,  on 
which  the  greater  transparency  and  solubility  of  the  crystals  de- 
pend.    The  purpose  of  this  large  production  of  the  granular  phos- 


SECKETION    OF    THE    VESICUL^    SEMINALES.  313 

phate  of  lime  is,  I  believe,  to  sustain  the  neutral  reagency  of  the 
fluid. 

The  ducts,  or  so-called  cells  of  the  prostate  gland,  being  lined 
by  the  genito-urinary  mucous  membrane,  have  been  considered  as 
furnishing  a  secretion  identical  with  that  membrane,  and  therefore 
unnecessary  to  fecundity.  The  unsoundness  of  this  opinion  is  evi- 
dent when  applied  to  the  other  gUmds  of  the  body,  inasmuch  as  the 
lining  membranes  of  all  glandular  organs  are  simple  inversions, 
variously  ramified,  of  the  same  mucous  membrane,  but  the  secretions 
of  the  various  glands  differ  very  materially  from  those  of  the  parent 
and  adjacent  mucous  membrane.  Glands  have  a  peculiar  secretion 
accommodated  to  their  situation  and  purpose;  and  the  purpose  as- 
signable to  the  secretion  of  the  prostate  gland,  although  not  of  an 
essentially  fecundating  nature,  is  one,  of  effecting  a  condition 
necessary  to  the  fecundating  action  of  the  seminal  fluid.  The  se- 
cretion of  the  mucous  membrane  of  the  urethra  is  usually  acid,  but 
at  times  an  alkaline  reagency  predominates,  arising  from  a  peculiar 
pathological  condition  of  that  membrane.  When  either  the  acid  or 
alkaline  reaction  is  in  excess,  a  deterioration  of  the  qualities  of  the 
fecundating  fluid  is  likely  to  happen,  which  deterioration,  by  de- 
stroying the  spermatozoa,  will  at  the  same  time  very  probably 
destroy  its  fertilizing  quality.  Conditions  of  excessive  acid  and 
alkaline  secretion  have  been  shown  to  be  not  uncommon  in  the 
mucous  membrane  of  the  vagina  and  uterus,  and  to  these  conditions 
sterility  is  no  doubt  often  to  be  ascribed. 

The  mucus  secreted  by  the  prostate  gland  is  charged  with  more 
or  less  of  the  phosphates  of  lime  and  soda,  and  it  is  secreted  and 
poured  out  in  a  situation  where  the  peculiar  properties  of  its  neu- 
tralizing salts  are  likely  to  be  made  available  for  an  immediate  use. 
I  cannot,  therefore,  believe  that  this  secretion  is  purposeless  in 
reference  to  fertilization,  or  that  it  merely  supplies  an  additional 
portion  of  mucus ;  nor  in  that  situation  the  salts  are  simply  the 
excretion  of  effete  matter.  For  these  reasons,  then,  it  appears  to 
me,  that  the  special  office  it  has  to  perform  is  that  of  counteracting 
the  injurious  effects  likely  to  arise  from  the  presence  of  the  abnormal 
acid  and  alkaline  conditions  of  the  secretion  of  that  portion  of  the 
mucous  membrane  appropriated  for  the  reception  and  conveyance 
of  the  seminal  fluid.  Thus,  though  not  actually  taking  a  primary 
and  direct  part  in  the  act  of  fecundation,  it  nevertheless  serves  a 
secondary  office  so  important,  as  to  make  that  function  depend  very 
materially  on  its  presence. 

In  a  diseased  atonic  state  of  the  prostate  gland,  the  action  of  the 
organ  is  insufficient  to  expel  the  secreted  salts,  and  thence  arises 
a  tendency  to  the  formation  of  calculi  in  its  cellules,  marking  a 
peculiar  condition  of  the  mucous  membrane. 

The  secretion  of  the  vesiculae  seminales  is  mucilaginous  and  trans- 
parent, containing  ovoid  bodies  of  pure  condensed  mucus,  floating 
in  a  small  quantity  of  the  same  mucous  substance  in  a  more  fluid 


344:  USES    OF    THE    VESICULAE    SECRETIOIS''. 

state.  When  mingled  with  the  mass  of  the  semen,  these  bodies 
float  on  account  of  their  less  specific  gravity.  Their  state  of  con- 
densation alters,  however,  when  the  secretion  is  allowed  to  stand 
exposed  to  the  air  for  a  few  hours  ;  the  ovoid  bodies  slowly  dissolve, 
and  the  resulting  fluid  diff'uses  itself  equally  through  the  mass  of 
the  semen,  the  denser  matters  subsiding  gradually  to  the  bottom. 

A  consideration  of  function  in  relation  with  the  fact  of  this  gra- 
dual solution  ofiers  an  interesting  suggestion.  It  would  appear  as 
if  the  vesiculiB  were  intended  to  supply  a  fluid  of  light  specific 
gravity,  by  which  the  vitality  and  freedom  of  the  spermatozoa  may 
be  longer  sustained  in  their  altered  situation,  and  their  presence 
rendered  more  effective  in  the  process  of  impregnation.  A  con- 
tinuous resolution  of  the  condensed  mucus  is  thus  made  to  afford  a 
means  of  preserving,  during  a  much  longer  time  than  would  other- 
wise be  the  case,  a  relative  condition  of  media  favorable,  if  not  in- 
deed necessary,  to  the  proper  accomplishment  of  impregnation. 

It  is  a  general  belief  that  the  fluid  of  the  testicles  is  continually 
secreted,  and  that  when  the  tubuli  become  overcharged,  the  excess 
is  conveyed  along  the  vas  deferens,  and,  passing  thence  by  a  re- 
trograde current  into  the  vesicular  seminalcs,  remains  accumulated 
there  until  removed  by  emission.  There  can  be  no  doubt  that  the 
tubuli  are  capable  of  a  certain  degree  of  expansion,  and  that  they 
are  able  to  accommodate  themselves  to  the  amount  of  secretion  pro- 
duced at  any  time  during  a  healthy  condition  of  the  organs.  There 
does  not  appear  to  be  a  necessity  for  supposing  an  accumulation 
of  seminal  fluid  beyond  an  amount  sufficient  for  the  nutrition  and 
elimination  of  the  spermatozoa.  The  circumstances  favorable  to 
its  production,  and  requiring  its  presence,  are  such  as  to  cause  an 
amount  of  activity  suflicient  for  the  immediate  secretion  of  as 
much  seminal  fluid  as  is  demanded  for  the  occasion,  in  the  same 
way  that  obtains  for  the  secretion  of  other  glands.  Again,  the 
secretions  of  the  vesiculce  and  testicles  arc  materially  different  in 
qualities  and  appearance,  which  could  not  be  the  case  were  they  in- 
termingled in  the  vesiculse  seminales  in  the  manner  supposed. 

The  distinguishing  character  of  the  testicular  fluid  is  the  presence 
of  spermatozoa.  A  carefully  conducted  search  has  never  enabled 
me  to  detect  spermatozoa  in  the  vesicular  mucus ;  neither  does  the 
latter  present  the  milky  appearance  which  the  secretion  of  the 
testicle  possesses.  I  am  satisfied,  therefore,  that  the  opinion  of 
the  vesiculse  being  receptacles  for  a  superabundant  secretion  from 
the  testicle  is  erroneous.  The  great  nervous  excitability  of  the 
testicles,  placed  as  they  are  under  the  immediate  domination  of  the 
brain,  enables  thera  to  effect  their  secretion  at  the  instant  required, 
that  is  to  say,  immediately  before,  and  during  the  act  of  coition, 
and  to  produce  their  proper  contribution  of  impregnating  fluid. 
The  onl}'  appearance  of  accumulation  is  that  observed  in  the  vesi- 
culjB — namely,  in  the  amount  of  condensation  which  takes  place  in 
the  mucus  while  it  remains  in  them.     This  is  certainly  evident  in  an 


SPEEMATIC    ANIMALCULES.  34-5 

alteration  of  density,  but  it  results,  not  from  excessive  accumulation 
of  the  secretion,  but  from  the  inspissation  always  going  on  by  exos- 
mosis  of  its  more  fluid  portion. 

It  has  also  been  supposed  that  there  is  a  constant  and  natural 
oozing  away  of  the  seminal  fluid  secreted  in  excess,  but  I  consider 
this  idea  quite  as  improbable  as  the  former.  In  cases  where  this  loss 
of  secretion  has  been  observed,  it  has  undoubtedly  been  the  result 
of  morbid  action.  Again,  the  fallacy  of  supposing  accumulation  of 
testicular  fluid  in  the  vesiculae  is  analogically  demonstrated  in  the 
instance  of  the  elephant,  and  some  other  animals,  by  the  separation 
of  the  two  sets  of  organs,  which  are  placed  in  such  difl"erent  positions 
that  no  communication  whatever  can  subsist  between  them. 

The  function  of  the  testicles  is  the  secretion  of  a  slightly  opaque, 
whitish  mucus,  which  fills  up  the  tubuli  of  the  testis,  the  vasa  eff'e- 
rentia,  epididymis  and  vas  deferens,  and  is  the  actual  fertilizing 
fluid  jjar  excellence^  requiring  only  conveyance  to  the  ovule  of  the 
female  ovarium  to  accomplish  fecundation.  Of  the  ultimate  des- 
tination of  this  fluid,  and  its  mode  of  action,  our  knowledge  is 
limited  to  a  few  facts.  We  know,  for  example,  that  fecundation 
cannot  take  place  in  the  female  without  it,  and  judging  from  ana- 
logy, probably  without  its  actual  contact  with  the  ovum;  that  a 
suspension  of  its  production  in  the  male  causes  an  arrest  in  the  ca- 
pability of  procreation,  and  that  the  removal  of  the  testes  efl'ectually 
takes  awa}''  that  power.  Beyond  these  known  phenomena  we  enter 
for  our  explanations  upon  the  domain  of  metaphysics. 

Floating  in  the  mucus  contained  in  the  tubuli  seminiferi  are  to 
be  found  the  spermatozoa.  The  spermatozoa  are  the  distinguishing 
element  of  this  secretion,  and  determine  its  identity.  They  exist 
in  more  or  less  abundance,  and  as  on  them  depends  the  accomplish- 
ment of  fecundation,  so  they  become  the  proof  of  the  conditions  of 
health  in  the  generative  organs.  They  are  not  present  in  the  semi- 
nal tubes  before  puberty,  and  they  diminish  with  the  failing  powers 
of  age,  attending  most  intim.ately  on  the  period  of  virility.  Under 
some  forms  of  disease  they  also  disappear,  and  their  absence  is 
characterized  by  impotence. 

If  there  be  few  of  these  animalcules  existing  in  a  large  mass  of 
fluid  submitted  to  microscopical  examination,  the  demonstration  of 
their  presence  is  difiicult,  a  circumstance  which  may  probably  have 
led  some  observers  to  doubt  their  existence.  But  when  brought 
under  the  eye  they  are  easily  seen,  and  with  a  comparatively  low 
magnifying  power.  Donne,  in  speaking  of  some  of  their  character- 
istic peculiarities,  has  drawn  a  distinction  between  them  and  the 
infusoria  (sometimes  found  in  the  urine),  on  which  he  has  based  a 
suggestion  of  importance,  in  relation  with  their  discovery  in  that 
fluid  in  cases  of  suspected  spermatorrhoea.  After  remarking  on 
the  facility  with  which  the  infusoria  are  destroyed,  he  mentions  the 
remarkable  power  of  resistance  to  diff"erent  sources  of  destruction 
possessed  by  the  spermatozoa,  as   is  illustrated   by  the  preservation 


346  SPERMATIC    ANIMALCULES. 

of  their  foi-ro  after  boiling,  and  their  remaining  uninjured  in  putrid 
urine  for  an  indefinite  length  of  time. 

The  internal  structure  of  these  beings  has  not  yet  been  detected 
on  account  of  their  minuteness,  but  their  outline  is  well  defined. 
The  form  of  the  body  is  an  oblong  cylinder,  swelling  slightly  in  the 
middle.  From  the  anterior  part  of  this  body  projects  a  slight  emi- 
nence, which  appears  from  its  situation  to  be  the  head.  The  tail 
is  of  great  length,  being  at  least  ten  times  that  of  the  body,  and 
tapers  to  a  very  acute  point,  the  place  of  its  junction  with  the  body 
being  well  marked.  Whilst  swimming  about  in  the  fluid,  which  they 
do  with  great  vigor,  the  tail  is  thrown  into  the  waves,  and  the 
body  is  made  to  advance  by  a  spiral  motion.  They  turn  readily 
out  of  the  way  of  any  obstruction,  but  they  have  not  the  backward 
motion  of  vibriones.  The  nature  of  the  cause  and  existence  of  these 
curious  beings  is  involved  in  considerable  mystery,  and  the  mode 
of  their  propagation  in  the  seminal  tubes  is  not  easy  to  explain. 
The  source  of  their  nourishment,  for  without  nourishment  they  could 
not  live,  raises  a  highly  interesting  question.  That  they  have  inde- 
pendent existence  there  can  be  no  doubt,  and  that  their  lives  may 
be  sustained  under  suitable  circumstances,  away  from  the  situation 
of  their  first  production,  there  is  abundance  of  evidence.  They 
have  been  found  alive  in  the  uterus  and  Fallopian  tubes  twenty  days 
after  ejection,  and  yet  their  nourishment  must  be  derived  from  the 
vital  fluid,  and  probably  therefore  by  its  constant  destruction. 

Jourdan,  speaking  of  the  parasites  of  the  human  body,  and  the 
spermatozoa  have  an  existence  analogous  at  least  to  that  of  such 
parasites,  says:  "In  fact,  as  infusory  animalcules  appear  wherever 
conditions  favorable  to  their  development  are  present,  the  same 
takes  place  in  living  man.  The  most  important  of  these  conditions 
seems  to  be  a  degree,  however  feeble,  of  decomposition,  such  as  is 
observed  in  a  normal  state  in  the  excretions,  or  as  a  pathological 
phenomenon  in  some  of  the  liquids  of  the  body."  [Encyclopedie 
Anatomique,  tome  ix.  p.  395.) 

Henlc  conceives  spermatozoa  to  be  possessed  of  an  extraordinary 
amount  of  vitality,  for  he  states  that  he  has  seen  motion  taking  place 
in  tails  separated  and  lying  apart  from  their  bodies.  I  have  often 
seen  separated  tails,  but  I  never  detected  in  them  any  appearance  of 
motion.  AVagner  noticed  [Elements  of  Special  Physiologij)  "  on 
one  or  two  occasions,  the  caudal  end  of  the  body  to  be  double,  bifid, 
or  forked,  and  once,  too,  the  body  appeared  to  be  double,  as  in  a 
bicephalous  monster."  This  latter  occurrence  I  have  also  seen, 
and  I  felt  at  the  time  inclined  to  refer  it  to  that  mode  of  propagation, 
known  as  gemmation^  so  general  among  the  polypes  and  infusoria. 
In  the  single  instance  in  which  I  observed  this  phenomenon,  the 
two  bodies  were  connected  together  at  the  seat  of  the  junction  of 
the  body  and  tail.  The  younger,  which  was  slightly  the  smaller, 
was  joined  to  the  elder  by  a  very  short  footstalk,  and  appeared  to 
be  ready   to  separate.      To   this  circumstance,  namely,  generation 


SPERMATIC    ANIMALCULES.  347 

hj  geraraation,  as  well  as  the  fact  of  finding  separate  tails,  I  am 
inclined  to  refer  for  an  explanation  of  the  presence  of  several  bodies 
in  the  seminal  fluid  unfurnished  with  tails,  but  nevertheless  endowed 
with  the  power  of  motion.  Most  of  the  species  of  infusoria  have  the 
remarkable  power  of  propagation  by  gemmation,  as  well  as  by  ova, 
and  I  have  an  impression  that  the  same  happens  with  regard  to  the 
spermatozoa.  I  am  not,  however,  inclined  to  urge  this  idea  very 
strongly,  merely  on  the  strength  of  a  single  observation,  though  I 
consider  it  sufficiently  worthy  of  attention,  to  justify  further  exami- 
nation into  the  question.  Donne  has  given  drawings  in  his  Cours 
de  Microseopie  of  spermatozoa  taken  from  the  dormouse,  from  which 
it  would  appear  that  reproduction  by  gemmation  does  actually  take 
place. 

There  are  other  bodies  met  with  in  the  seminal  fluid — namely,  the 
spermatophori.  These  are  supposed  to  be  the  source  whence  the 
spermatozoa  are  derived,  and  consist  of  compound  cells  of  different 
magnitude,  containing  within  them  a  granular  substance.  Koelliker 
pursued  the  subject  of  the  evolution  of  the  spermatozoa  through 
various  gradations  of  the  lower  animals,  extending  his  researches 
upwards  to  man.  He  arrived  at  the  conclusion  that  the  spermato- 
phori are  the  source  whence  the  spermatozoa  are  evolved,  and  this 
evolution  he  has  detected  in  the  human  species. 

Such  an  investigation,  however,  is  surrounded  with  difficulties, 
and  with  no  small  amount  of  uncertainty.  Wagner  demonstrated 
the  same  evolution  from  the  spermatophori  of  birds.  By  the  aid 
of  analogy,  and  on  such  authority,  therefore,  we  must  consider  the 
evidence  of  this  one  mode  of  reproduction  of  the  spermatozoa  as  de- 
termined, but  there  is  no  reason  for  supposing  that  reproduction 
by  gemmation  may  not  also  occur.  Indeed,  where  such  constant 
change  in  accumulation  and  diminution  is  taking  place  in  the  quan- 
tity of  the  semen,  and  the  spermatozoa  are  thus  liable  to  destruc- 
tion, it  is  natural  to  infer  that  the  means  of  their  reproduction 
would  be  secured  by  every  safeguard  that  nature  could  supply  for 
that  purpose. 

Besides  the  spermatic  animalcules  and  spermatophori,  there  are 
also  found  in  the  fluid  of  the  testicle,  minute  glistening  atoms,  which 
have  been  supposed  to  be  the  earlier  stages  of  development  of  the 
spermatophori. 

From  these  observations  we  may  conclude  that  much  has  already 
been  accomplished  towards  a  knowledge  of  the  development  and 
purposes  of  these  remarkable  animalcules.  But  there  are  still  many 
points  requiring  more  accurate  elucidation,  particularly  the  question 
of  structure.  Some  physiologists  of  the  present  day  doubt  even  the 
separate  vitality  of  the  spermatozoa.  The  improvements  of  the 
microscope,  and  the  greater  distribution  of  that  instrument,  with 
the  necessarily  increased  facilities  of  manipulation,  will  however 
tend  by  degrees  to  put  all  doubt  on  the  subject  out  of  the  question, 
and  clear  up  all  our  present  difficulties  in  respect  to  this  interesting 
physiological  inquiry. 


848  PATHOLOGY    OF    SPERMATOEEHCEA. 

CHAPTER  III. 

PATHOLOGY  OF  SPERMATORRHOEA. 

The  term  spermatorrhcBa  means  simply  an  involuntary  discharge 
of  seminal  fluid.  The  disease  intended  to  be  represented  is  more 
than  this,  since  it  is  characterized  by  a  series  of  consecutive  symp- 
toms, more  or  less  important,  developed  in  the  constitution  of  the 
sufferer,  and  of  which  an  involuntary  discharge  of  seminal  fluid  is 
only  one,  but  at  the  same  time  the  chief  of  these  symptoms.  It  is 
seldom  that  the  malady  depends  merely  on  the  derangement  of  a 
single  organ  ;  the  different  portions  of  the  genital  apparatus  parti- 
cipate in  a  general  irritation,  and  constitute  essentially  the  disease, 
lu  a  state  of  health  the  genital  organs  have  a  combined  dependence 
on  each  other,  and  when  diseased,  they. are  capable  of  exercising  a 
separate  influence  in  the  aggravation  of  particular  symptoms.  An 
observation  of  the  results  of  disease  on  separate  parts  of  the  genital 
system  leads  me  to  conclude,  that  the  structure  and  functions  of  each 
organ  may  be  affected  independently  of  the  rest.  When  a  single 
organ  alone  is  deranged,  the  disease  presents  the  simplest  form  of 
spermatorrhoea. 

With  a  complication  of  independent  actions,  it  is  not  surprising 
that  symptoms  Avhich  arise  apparently  from  the  same  cause  should 
assume  opposite  forms  in  certain  cases.  Many  interesting  and  re- 
markable circumstances  of  this  kind  have  occurred  to  me  in  prac- 
tice, and  the  necessity  for  determining  their  relative  influence,  and 
satisfactorily  referring  them  to  their  proper  origin,  led  me  in  the 
first  place  to  contrive  some  mode  of  classification.  With  this  in- 
tention, I  constructed  the  following  table,  which  has  proved  of  es- 
sential service  to  me  in  enabling  me  to  refer  to  their  proper  source 
many  of  the  peculiar  symptoms  of  spermatorrhoea. 

A  primary  division  of  the  disease  may  be  made  into  the  two  forms 
of  Tonic  and  Atoxic,  under  the  designation  of  Spermatorrhcea 
Sthenica,  and  Spermatorrhcea  Astuexica.  Following  the  ar- 
rangement of  the  table,  it  will  be  seen  that  the  sthenic  and  asthenic 
condition  of  the  same  organ  occasions  in  it  different  modifications  of 
the  disease,  in  proportion  as  the  symptoms  that  result  are  varied  b}' 
the  peculiar  influence  of  structure  and  function. 

SPERMATORRHCEA  STHENICA. 

[Spermatourucea  Extoxica — Mason  Good.] 

STEUCTrRE.  FC.VCTrOX. 

m^,^^„  n    ij-  f  Excessive  secretion ;  relative  deficieucv 

iESTES    ....      Orchitis <         I.  J. 

\      of  spermatozoa. 

VESict7L.E  Semi-     1 

>  Vesiculitis   ....        Excessive  secretion  ;  -with  inspissation. 


PATHOLOGY    OF    SPERMATOKKKCEA.  349 

Excessive  secretion ;  increased  amount 
of  salts. 
Urethra     .     .     .      Urethritis    ....         Excessive  secretion  of  mucus. 


r  E 
Prostate  Glaxd  .     Prostatitis  ....      \        e      i^ 

(      of  salts. 


SPEFtMATORRHCEA  ASTHENICA. 
[Speematorrhcea  ATO^"ICA — Mason  Good.] 

STRUCTURE.  FUXCTIOX. 

rr„„„  „  A,       i  r  Impotence ;  watery  secretion;  absence 

Iestes    ....     Atrophy      .     .     .     .      \       *^„  ,  •'  ' 

•*    -^  I      Oi  spermatozoa. 

'  >  Irritability ....         Watery  secretion. 

^AJj£S  •       •        •        •  J 

■D,„  /^  />,       ■    T    -J  J-  f  Diminished  secretion  and  salts;  deposit 

Prostate  Glaxd  .      Chronic  Irritation     .      \         n      ,     ^■  >       i- 

(      of  calculi. 

Urethra     .     .     .      Ulceratioyi  ....         Purulent  discharge. 

It  cannot  be  admitted  as  a  necessary  law  of  healthy  individual 
existence,  that  the  organs  of  generation  should  be  brought  into  ex- 
ercise. The  functions  of  the  body  may  be  carried  on  perfectly  well 
without  their  employment.  On  the  other  hand,  taking  society  as 
at  present  constituted,  and  considering  the  large  amount  of  nourish- 
ment usually  taken  into  the  system,  it  must  be  allowed  that  the 
moderate  use  of  the  generative  organs  is  perfectly  consistent  with 
the  highest  degree  of  health.  By  moderate  use  of  this  function, 
and  by  the  healthful  activity  which  accompanies  its  exercise,  the 
general  system  is,  to  a  certain  extent,  relieved  and  lightened,  and 
the  tone  both  of  mind  and  body  improved.  The  too  frequently  re- 
peated exercise  of  this  function,  on  the  other  hand,  is  apt  to  occa- 
sion an  unhealthy  state  of  excitement  of  the  organs,  which  is  prone 
to  terminate  in  disease.  After  a  time  the  morbid  excitement,  as- 
suming by  continuance  a  chronic  character,  takes  on  an  action  inde- 
pendent of  its  cause,  progresses  gradually,  and  occasions  a  constant 
secretion  of  seminal  fluid.  The  exhaustion  proceeding  from  so  ab- 
normal and  constant  a  drain  upon  the  powers  of  the  constitution, 
quickly  undermines  the  most  vigorous  strength,  and  establishes  a 
state  of  serious  disease. 

The  secretion  of  the  seminal  fluid,  destined  for  the  important 
purpose  of  preserving  the  species,  demands  for  its  perfection,  if  not 
the  highest  at  least  a  high  standard  of  vital  energy.  Its  excessive 
loss,  for  the  same  reason,  occasions  an  immediate  and  destructive 
impression  on  the  health.  This  symptom,  therefore,  as  the  most 
obvious,  and  appai-ently  the  most  dangerous,  will  naturally  attract 
the  attention  of  the  medical  practitioner,  and  probably  induce  him  to 
direct  the  entire  of  his  efforts  to  accomplish  its  removal.  Lallemand 
based  his  system  of  classification  on  the  character  of  the  emissions, 
dividing  them  into  nocturnal  and  diurnal.  A  careful  consideration 
of  the  importance  of  the  symptoms  he  has  attached  to  each  division, 
shows  that  the  idea  these  terms  convey  does  not  clearly  define  his 
meaning.  His  arrangement  resolves  itself  more  into  a  question  of 
degree,  among  a  certain  set  of  symptoms,  controlled  by  peculiar  cir- 
cumstances, than  of  diff'erence  in  the  pathological  conditions  of  the 
structure  affected. 


350  PATHOLOGY   OF    SPEEMATOERHCEA. 

Emission  is  nothing  more  than  the  effect  of  some  previous  condition 
of  stimulus  or  excitement.  The  classification  of  the  species  of  sper- 
matorrhoea, by  the  variations  of  this  one  symptom,  even  though  that 
symptom  be  most  important,  must  create  uncertainty  as  to  the  part 
of  the  apparatus  to  which  the  seat  of  the  morbid  action  should  be 
assigned.  Nocturnal  emissions,  arising  from  excessive  activity  of 
the  organs,  are  looked  upon  as  showing  the  first  stage  of  the  dis- 
ease. They  are  attended  with  all  the  evidences  of  the  normal  state, 
by  erection,  and  by  venereal  ecstasy.  They  are  to  be  attributed 
to  the  reaction  on  the  brain  of  the  local  nervous  excitability,  oc- 
curring either  during  partial  sleep,  or  in  active  conditions  of  the 
imagination.  Diurnal  emissions,  on  the  contrary,  are  marked  by 
an  absence  of  venereal  desire  and  ecstasy,  by  an  absence  of  sper- 
matic fluid,  and  an  equal  absence  of  erection,  and  all  sthenic  condi- 
tion. 

A  division  has  also  been  proposed,  characterized  by  emissions 
occurring  in  the  same  individual  both  by  day  and  night.  This  can- 
not, however,  be  received  as  a  clearly  separate  state,  but  rather  as 
combining  the  different  stages  of  the  two  former  conditions,  or,  per- 
haps, more  correctly,  the  stage  of  diurnal  emissions  accompanied 
by  occasional  erection  of  the  penis.  But  these  terms,  nocturnal 
and  diurnal,  evidently  do  not  express  the  conditions  of  the  affected 
parts  with  sufficient  precision.  The  structural  and  functional  dif- 
ferences are  capable  of  more  exact  discrimination,  and  are  suffi- 
ciently distinct  to  enable  us  to  estimate  the  symptoms  separately, 
as  depending,  for  example,  on  affections  of  the  testicles,  vesiculse 
seminales,  prostate  gland,  or  urethra. 

Before  proceeding  to  the  separate  consideration  of  these  latter 
forms  of  the  disorder,  it  may  however  be  well  to  remark,  that  the 
laws  by  which  the  spermatozoa  are  governed  differ  altogether  from 
those  affecting  the  structures  or  functions.  The  existence  of  these 
animalcules  is  independent  of  the  functional  power,  independent 
even,  as  I  have  already  pointed  out,  of  the  place  of  their  produc- 
tion ;  and  they  may  be  present  or  absent,  for  reasons  quite  irrespec- 
tive of  the  healthy  condition  and  fertilizing  quality  of  the  semen. 
So  long  therefore  as  disease  of  the  testicle  produces  no  essential 
change  in  the  quality  of  the  secreted  fluid  which  affords  them  nou- 
rishment, the  spermatozoa  will  continue  to  be  reproduced  at  about 
the  same  average  rate.  As,  however,  the  quantity  of  the  fluid  may 
be  largely  increased  by  excessive  action,  without  any  material 
change  in  its  character,  so  will  it  happen  that  the  number  of  sper- 
matozoa in  relation  to  the  bulk  of  the  secretion  may  be  diminished. 

SPERMATORRHCEA    STHENICA    TESTICUL^. 

Sthenic  spermatorrhoea,  arising  from  disease  affecting  the  struc- 
ture of  the  testicle,  is  attended  with  inflammatory  symptoms  more  or 
less  acute.      The  testicles  are  swollen  and  painful  on  pressure,  a 


PATHOLOGY    OF    SPERMATOERHCEA.  351 

sense  of  weight  extends  along  the  spermatic  cord,  accompanied 
usually  with  pains  in  the  loins,  and  with  all  those  symptoms  which 
constitute  an  ordinary  attack  of  inflammation  of  the  testicle,  or  or- 
chitis. It  seldom  happens,  however,  that  orchitis,  originating  in 
this  way,  is  attended  with  resolution  of  substance  and  purulent  de- 
position, even  although  the  early  stages  of  the  inflammatory  action 
be  attended  by  a  considerable  amount  of  severity.  The  function  of 
the  testicle  is  greatly  stimulated  by  the  excitement,  and  the  secre- 
tion of  spermatic  fluid  is  largely  increased.  The  peculiar  influence 
of  this  excitement  is  shown  by  erection  of  the  penis,  and  emissions, 
and  I  have  observed  that  so  long  as  spermatic  fluid,  possessing  a 
fecundating  power,  is  secreted  by  the  testicles,  its  emission  is  con- 
stantly attended  by  erection. 

SPERMATOERHCEA    ASTHENICA    TESTICULiE. 

When  the  sthenic  state  has  existed  for  some  little  time,  a  material 
change  takes  place  in  the  symptoms,  with  respect  to  structure  and 
function.  The  activity  that  characterized  the  earlier  stages  of  the 
disease  gives  place  to  a  condition  of  atony,  and  loss  both  of  sub- 
stance and  power  ensues.  This  is  the  spermatorrhoea  asthenica. 
The  orchitis  is  relieved  in  proportion  as  the  structural  excitement 
ceases,  but  function  is  sacrificed  at  the  same  time.  The  testicles 
begin  slowly  to  diminish  in  size  as  their  structure  is  absorbed,  and 
they  become  flaccid  and  shrivelled.  The  spermatic  secretion  as- 
sumes a  watery  character,  gradually  ceasing  altogether,  and  the 
spermatozoa  disappear.  This  condition  of  the  function  of  the  tes- 
ticle is  quickly  followed  by  complete  impotence.  Severe  and  dan- 
gerous effects  to  the  constitution  naturally  accompany  these  changes. 
The  brain  and  nervous  system,  on  which  the  testicles  depend  for 
their  activity,  are  continually  being  exhausted  by  eff"orts  for  the  re- 
storation of  the  functional  power  of  the  latter,  and  the  constitutional 
symptoms  assume  characters  of  the  highest  degree  of  irritability. 

SPERMATOERHCEA    STHENICA   VESICUL^. 

The  vesiculffi  seminales  are  differently  constituted,  in  reference 
to  their  morbid  phenomena,  to  the  testicles.  The  results  of  exces- 
sive action  in  them  are  the  direct  opposite  to  those  produced  by  ir- 
ritation of  the  testicles.  They  have  no  special  function  to  perform 
dependent  upon  nervous  influence  for  its  completion.  Their  secre- 
tion is  only  an  important  accessory  to  that  of  the  testicles.  The 
injurious  eff"ects  to  the  constitution,  of  diseases  aff"ecting  them,  are 
seldom  first  shown  by  impressions  on  the  nervous  system.  Their 
irritable  activity  increases  with  the  continuance  of  excitement,  and 
instead  of  being  relieved  by  the  excited  function,  they  acquire  a 
permanence  of  morbid  action,  by  which  the  constitution  is  seriously 
undermined. 

The  sthenic  state  of  spermatorrhoea  in  relation  with  the  vesicular 


352  PATHOLOGY    OF    SPERMATOERHCEA. 

seminales  is  attended  with  in3ammatoi\y  action,  as  shown  by  the  ex- 
citement of  those  organs,  though  this  inflammation  does  not  rise  to 
any  high  degree  of  intensity.  I  have  designated  this  state  by  the 
term  vesiculitis,  meaning  thereby,  an  inflammatory  condition  of  the 
structure  of  the  vesicul^.  It  is  attended  by  a  sensation  of  dull  pain 
or  aching  at  the  back  of  the  bladder,  becoming  more  painful  as  the 
latter  organ  is  distended  with  urine.  The  eff'ect  of  inflammation 
on  the  function  of  the  vesiculas  is  an  excessive  increase  in  the  quan- 
tity of  their  secretion,  which  escapes  under  almost  every  sudden 
contraction  of  the  surrounding  muscles. 

The  coats  of  the  vosiculce  are  thin  and  fibrous,  and  admit  of  an 
active  exosmosis.  Inflammation  sometimes  increases  this  exosmosis, 
and  by  that  means  the  fluid  portion  of  the  secretion  is  more  rapidly 
removed,  the  consequence  being  inspissation  of  their  contents  to  a 
degree  amounting  occasionally  to  almost  complete  solidification. 
When  this  happens  to  any  great  extent,  and  the  cellules  of  the  vesi- 
cula3  become  much  distended,  their  structure  is  liable  to  undergo 
destructive  absorption. 

A  less  degree  of  inflammation  often  occurs,  by  which  the  secre- 
tion, instead  of  preserving  its  pure,  transparent  condition,  assumes 
the  appearance  of  pus. 

SPERMATORRHEA   ASTHENICA   VESICUL^. 

After  inflammation  of  the  vcsicula;  has  lasted  for  an  uncertain 
time,  the  active  symptoms  gradually  cease,  leaving  behind  an  atonic 
or  asthenic  condition.  This  condition  is  associated  with  irritability, 
in  a  greater  or  less  degree,  and  the  functional  result  is  the  produc- 
tion of  a  watery  secretion,  and  a  gradual  diminution  in  the  quan- 
tity of  that  secretion.  Impotence  may  arise  from  this  cause,  with- 
out an  actual  deterioration  of  the  fecundating  fluid  of  the  testicle, 
although  it  is  rare  for  one  of  these  diseased  states  to  happen  inde- 
pendently of  the  other. 

When  the  vesiculse  have  become  distended  with  secretion,  either 
naturally  or  under  excitement,  their  evacuation  may  be  attained  by 
the  contraction  of  their  coats,  or  by  the  mere  physical  eff'ect  of  exces- 
sive distension,  by  pressure  from  repletion  of  the  rectum,  contraction 
of  the  levatores  ani  muscles,  or  compression  of  the  viscera  of  the  pel- 
vis, occasionedby  the  position  of  the  body,  as  in  sitting.  These  efl"ects, 
it  is  evident,  may  take  place  independently  of  disease,  and  if  rarely 
called  into  exercise,  we  should  hardly  look  for  serious  eff"ects  from 
them  alone.  On  the  other  hand,  if  the  evacuation  take  place  fre- 
quently, more  or  less  serious  effects  will  result  from  its  repetition, 
for  we  may  be  sure,  whether  the  cause  be  morbid  or  otherwise,  that 
so  unnatural  a  mode  of  evacuation  could  not  take  place  without  the 
presence  of  a  morbid  cause.  The  simple  emission  of  this  fluid  can 
have  little  or  no  effect  upon  the  constitution  of  the  patient,  but  the 
debility  and  exhaustion  which  succeed  are  occasioned  by  the  often  re- 


PATHOLOGY    OF    SPEEMATOEEHCEA.  353 

peated  nervous  excitations,  or  efforts  which  are  rendered  necessary 
for  the  restoration  of  the  lost  secretion.  It  is  therefore  very  unwise 
to  consider  and  to  treat  the  mere  injection  as  the  actual  disease. 

The  nervous  phenomena  here  referred  to  are  not  those  which  ac- 
company a  state  of  healthy  stimulus,  but  are  the  direct  effect  of 
that  morbid  state  termed  irritability.  A  continuance  of  this  morbid 
condition  would  lay  the  foundation  for  the  destruction  of  the  organs 
themselves,  and  so  much  of  the  general  system  as  might  be  brought 
by  sympathy  under  the  same  morbid  influence.  The  muscles  in 
these  cases  become  wasted,  the  quantity  of  blood  diminishes,  it  loses 
its  red  globules,  and  the  digestive  organs  and  their  secretory  glands 
undergo  a  gradual  but  total  derangement.  These  conditions  usually 
come  on  slowly,  and  without  the  demonstration  of  any  very  sudden 
symptoms.  Should  they  continue  long,  the  vital  power  will  be  ex- 
hausted, and  the  constitution  laid  open  to  the  invasion  of  still  more 
acute  and  serious  disorders. 


SPERMATORRHCEA  STHENICA  PROSTATA. 

The  prostate  gland  is  liable  to  numerous  and  complex  changes, 
by  which  the  symptoms  affecting  it,  and  depending  peculiarly  on 
spermatorrhoea,  are  very  apt  to  be  obscured.  Like  the  other  asso- 
ciated organs,  however,  it  is  subjected  to  sthenic  and  asthenic  con- 
ditions ;  the  first  of  which,  exhibiting  all  the  evidences  of  inflamma- 
tion, I  have  named  prostatis.  The  structural  effects  of  the  disease 
are  the  same  as  those  accompanying  excitement  of  the  prostate 
gland,  arising  from  other  causes.  In  the  active  form  of  the  disease 
abscess  of  the  prostate  is  liable  to  take  place,  and  the  presence  of 
that  affection  is  evinced  by  a  discharge  of  purulent  mucus.  The 
functional  activity  of  the  organ  is  much  increased  under  the  in- 
fluence of  morbid  irritation,  and  there  is  a  copious  production  of 
mucus  containing  a  superabundance  of  phosphatic  salts.  The  quan- 
tity of  these  salts  varies  considerably  under  different  circumstances, 
independently  of  alterations  in  the  more  fluid  portions  of  the  secre- 
tion ;  and  these  variations  generally  indicate  some  peculiarity  in 
the  progress  of  the  disease,  while  the  immediate  effect  of  extreme 
dilution  of  the  prostatic  mucus  is  that  of  rendering  its  neutralizing 
power  insufficient  for  the  preservation  of  the  fecundating  fluid  against 
the  destructive  reagency  of  mucic  and  other  acids  present  in  the 
urethra. 

Concentration  of  the  prostatic  fluid  may  also  take  place  to  such 
an  extent  as  to  permit  the  formation  of  crystals  of  phosphate  of  lime, 
which  give  rise  to  much  irritation,  both  in  the  gland  itself,  and  to 
the  mucous  membrane  of  the  urethra  in  its  passage  along  that  canal. 
To  this  circumstance,  as  it  appears  to  me,  some  of  the  forms  of  blen- 
norrhoea  may  be  referred  ;  such  as  that  which  consists  in  a  discharge 
of  thick  greenish  yellow  mucus,  and  is  independent  of  any  impure 
origin. 


354  PATHOLOGY    OF    SPEKMATORRHCEA. 

SPERMATORRHCEA  ASTHENICA  PROSTATJS. 

In  the  asthenic  morbid  state  of  the  prostate  gland,  the  effect  taking 
place  is  an  irritability,  which  may  be  termed  chronic,  as  distinguish- 
ing it  from  the  active  irritability  accompanying  the  inflammatory 
condition  of  prostatitis.  The  gland  loses  its  power  of  producing 
healthy  mucus ;  the  secretion  becomes  watery  and  diminished  in 
quantity,  and  the  salts  remain  behind  in  the  ducts,  and  there  aggre- 
gate and  form  calculous  concretions.  Chronic  irritability  most 
generally  occasions  enlargement  of  the  gland,  with  the  production 
of  impediments  to  the  free  passage  of  urine.  The  symptoms  indi- 
cative of  disease  of  the  prostate  ghmd  are  commonly  felt  in  the  re- 
gion of  the  neck  of  the  bladder,  and  the  lower  part  of  the  rectum. 

SPERMATORRHCEA  URETHRA. 

The  mucous  membrane  of  the  urethra  must  necessarily  have  a 
place  in  any  system  of  classification  of  the  common  phenomena  of 
spermatorrhoea.  It  may  be,  and  undoubtedly  is,  difficult  to  point 
out  positive  evidences  of  the  presence  of  tiiis  disease  in  the  urethral 
membrane,  but  we  must  not  on  that  account  be  deterred  from  their 
investigation  and  consideration.  There  are  two  important  and  dis- 
tinctive states  which  constitute  the  foundation  of  a  classification  of 
the  diseases  of  this  part — namely,  urethritis,  and  ulceration  of  the 
mucous  membrane  ;  the  former  representing  the  sthenic,  the  latter 
the  asthenic  condition.  Urethritis  is  attended  with  more  or  less 
generally  a  considerable  discharge  from  the  mucous  membrane,  and 
all  the  symptoms  of  acute  inflammation.  From  the  inflamed  mem- 
brane irritation  may  be  propagated  throughout  the  whole  of  the 
generative  apparatus,  producing  peculiar  effects  in  each  separate 
portion. 

Ulceration  of  the  mucous  membrane  of  the  urethra  indicates  a 
condition  of  depressed  nervous  energy,  in  which  most  of  the  sur- 
rounding organs  participate,  to  the  destruction  of  their  natural 
sensibility. 

Ilaviuii  thus  examined  the  diseased  conditions  of  the  different 
portions  of  the  genital  apparatus  separately,  I  must  remind  the 
reader  that  such  states  of  complete  isolation  rarely  or  never  occur  in 
practice.  On  the  contrary,  it  constantly  happens  that  the  whole  of 
the  associated  organs,  without  exception,  are  involved  in  one  con- 
fused assemblage  of  symptoms,  which  will  require  much  care  to  dis- 
entangle and  distinguish  with  accuracy.  The  due  reference  of  each 
symptom  to  its  proper  source,  and  a  knowledge  of  the  diseased  alter- 
ations of  each  portion  of  the  genital  system,  constitute  in  reality  the 
pathology  of  spermatorrhoea. 


IMPOTENCY.  355 

CHAPTER  IV. 

IMPOTENCY. 

The  subject  of  impotency  has  been  partially  discussed  when  con- 
sidering the  condition  of  the  testicles,  under  the  head  of  asthenia  of 
those  organs  in  my  table  of  classification.  That  reference  was  more 
particularly  directed  to  functional  incapacity,  resulting  from  altera- 
tion of  structure  of  the  testicles,  and  consequent  change  in  the  con- 
stitution of  the  seminal  fluid,  such  change  being  induced  by  sperma- 
torrhosa. 

Impotency,  such  as  I  am  now  about  to  direct  attention  to,  has, 
however,  an  existence  altogether  independent  of  the  above  disease. 
It  consists  in  an  imperfect  development  of  the  generative  power,  or 
its  partial  or  complete  abnegation  ;  the  former  succeeding  to  a  de- 
fective organization  of  the  apparatus  of  generation,  the  latter  to  an 
asthenic  alteration  in  the  condition  of  the  same  parts ;  the  result  of 
the  presence  of  these  conditions  being  an  incapability  of  propagat- 
ing the  species.  This  definition  of  the  term  gives  a  wide  scope  for 
the  introduction  of  collateral  causes,  and  points  out  many  minute 
circumstances  capable  of  exciting  the  malady. 

The  most  remarkable  character  connected  with  this  disease  is, 
that  the  organs  of  generation  are  rendered  unfit  for  the  performance 
of  their  natural  functions  without  the  exhibition  of  an  amount  of 
diseased  action  equivalent  to  the  incapacity  which  succeeds.  This 
character  appears  to  be  occasioned  by  certain  imperfections  and 
gradual  alterations  in  structure  of  the  parts  themselves,  by  which 
the  generative  function  becomes  arrested. 

The  fact  which  I  have  mentioned  in  a  former  portion  of  this  work, 
of  the  independence  of  individual  healthy  existence  of  the  function 
of  generation,  is  exemplified  in  the  perfect  state  of  health  which 
may  coexist  with  an  incapability  of  procreation.  The  active  per- 
formance of  this  function  demands  that  an  amount  of  nervous  in- 
fluence should  always  be  in  readiness  for  the  purpose  of  properly 
developing  its  eff'ects  ;  but  this  nervous  influence  may  not  be  called 
into  action.  The  expenditure  of  this  influence,  on  the  other  hand, 
would  occasion  those  inroads  upon  the  constitution,  which,  in  sper- 
matorrhoea, arise  from  the  frequent  repetition  of  the  nervous  phe- 
nomena. 

Imperfect  organic  development,  as  occasioning  impotency, 
presents  us  with  extreme  conditions,  though  at  the  same  time  the 
states  of  the  disease  are  so  definite,  as  almost  always  to  enable  us 
to  form  an  immediate  and  correct  judgment  as  to  the  result.  Thus, 
when  the  defective  organization  is  the  consequence  of  an)putation, 
or  serious  injury  to  the  penis,  of  non-evolution  of  the  testes,  or  of 


856  IMPOTENCY. 

defect  in  any  other  of  the  generative  organs,  the  nature  of  the  case 
itself  forbicis  every  chance  of  success.  Other  itnpediraents  admit 
of  removal,  such  as  phimosis,  incurvation  of  the  penis  from  short- 
eninf^  of  the  fi-ffinum,  and  partial  occlusion  of  the  orifice  of  the 
urethra.  The  knife  or  the  caustic,  under  such  circumstances,  offers 
ready  means  of  relief. 

Asthenic  impotency  shows  itself  by  a  deficiency  of  power  in 
the  generative  act,  and  assumes  gradually  a  state  of  more  or  less 
complete  incapacity  for  reproduction.  This  disease  is  brought  on 
by  several  causes,  one  of  the  most  influential  of  which  is  a  natural 
diminution  of  power,  resulting  from  inactivity  of  the  generative  func- 
tion. It  results  also  from  exhaustion  of  power,  following  excessive  in- 
dulgence in  a  life  of  debauchery ;  and  it  may  be  the  consequence  of 
paralysis  of  the  nerves  of  the  generative  organs.  When  impotency 
arises  from  causes  of  such  powerful  influence  over  the  constitution, 
the  treatment  naturally  ofl"ers  considerable  diflficulties,  but  the  case 
is  far  from  being  incurable. 

The  same  phenomena  sometimes  follow  from  blows  on  the  loins, 
and  from  other  means  of  concussion  to  the  spinal  cord. 

The  principle  of  treatment  in  this  affection  is  very  obvious.  The 
disease  is  attended  with  considerable  loss  of  power,  and  once  esta- 
blished, continues  to  exist  for  that  reason  ;  to  the  restoration  of  this 
lost  power,  all  means  should  be  made  subservient.  General  and 
local  tonics,  stimulants,  and  the  cold  bath,  are  the  modes  by  which 
this  end  may  be  accomplished ;  and  though  they  often  require  con- 
siderable time,  they  will  eventually  be  successful  when  properly  di- 
rected, and  sufficiently  persevered  in. 

There  is  a  set  of  symptoms,  however,  which  may  as  effectually 
prevent  the  continuance  of  the  species,  and  therefore  cause  impo- 
tency, as  those  I  have  named,  even  though  the  functional  power  may 
not  be  wanting.  These  symptoms  depend  remotehj  on  circumstances 
principally  affecting  the  nervous  system,  and  admit  of  treatment 
usually  with  a  fair  hope  of  success.  The  immediate  effects  are  oc- 
casioned by  irregularities  in  the  character  of  the  actual  emissions. 

The  first  of  these  diseases  is  the  consequence  of  high  nervous  ex- 
citement, developing  itself  in  the  structural,  instead  of  the  functional 
portion  of  the  generative  apparatus ;  producing,  in  fact,  a  state  of 
priapism.  It  naturally  happens  from  this  condition  of  the  parts, 
that  the  nervous  power,  which  ought  to  have  been  supplied  for  the 
stimulation  of  function  is  absorbed  in  the  production  of  structural  ex- 
citement, and  the  consequence  is  a  deficiency  in  emission,  and  there- 
fore, impotency.  The  mode  of  relief  in  a  case  of  this  kind,  is  to 
reduce  the  tendency  to  excitement  pervading  the  system  through  the 
constitution;  to  regulate  the  diet;  and  relieve  structural  excitement, 
by  directing  its  activity  to  another  channel,  through  the  means  of 
increased  muscular  exertion.  If,  as  sometimes  happens,  the  excite- 
ment occurs  from  some  abnormal  local  cause,  it  may  then  become 
necessary  to  apply  local  remedies  for  its  relief. 


IMPOTEXCY.  357 

The  venereal  organism  in  persons  of  great  nervous  irritability  is 
liable  to  cause  such  commotion  throughout  the  system,  and  to  stretch 
to  so  high  a  tension  the  excitement  of  the  brain,  as  occasionally  to 
induce  an  epileptic  spasm.  At  the  moment  of  such  a  seizure,  the 
continuance  of  other  excitations  would  cease,  and  with  them  natur- 
ally the  condition  of  excitement,  on  which  the  act  of  proper  emission 
depends.  Under  such  circumstances  impotency  follows  as  a  matter 
of  course.  The  frequent  recurrence  of  epileptic  attacks  so  caused, 
would  place  the  life  of  a  patient  affected  wdth  them  in  jeopardy,  and 
no  doubt  the  opportunity  for  such  recurrence  should  be  avoided ;  at 
the  same  time  I  am  forced  to  admit  that  occasional  indulgence  in  the 
practice  is  one  of  the  readiest  modes  of  subduing  over-excited  irrita- 
bility of  the  nervous  function.  The  treatment  of  this  form  of  impo- 
tency consists  in  reducing  the  irritation  of  the  system  by  depletive 
measures,  such  as  aperients,  and  a  strict  regimen. 

At  the  same  time  let  it  be  borne  in  mind,  that  due  judgment  must 
be  exercised  to  ascertain  whether  the  excitement  may  not  arise  from 
an  entirely  opposite  cause — namely,  from  debility  of  constitution, 
and  an  asthenic  irritability  of  the  generative  organs  inducing  reac- 
tion in  the  brain.  In  such  a  state  the  plan  of  treatment  will  consist 
in  supporting  the  constitution  by  tonic  and  stimulant  medicines,  and 
reducing  excessive  local  action  by  sedatives. 

Two  other  circumstances,  namely,  that  which  arises  from  a  too 
precipitate  emission,  and  that  which  arises  from  the  opposite  condi- 
tion of  a  too  tardy  one,  may  become  causes  of  impotency  ;  the  former 
from  the  emission  occurring  before  the  female  orgasm,  the  latter 
from  its  happening  afterwards.  The  first  of  these  states  depends 
upon  a  large  amount  of  irritable  excitement,  so  great  occasionally  as 
to  cause  emission  before  the  introduction  of  the  penis  into  the  vagina, 
the  second  from  deficient  excitement.  From  the  latter  circumstance 
it  happens  that  no  distinct  emission  does  actually  take  place,  but  that 
the  seminal  fluid  gradually  oozes  away  from  the  urethral  orifice. 
The  nature  of  these  cases  so  clearly  indicates  the  method  which 
should  be  adopted  in  their  treatment,  that  I  shall  be  excused  for  not 
dwelling  upon  them. 

Another  cause  of  impotency  connected  with  imperfection  in  the 
accomplishment  of  emission,  is  a  condition  of  the  urethra,  by  which 
the  seminal  fluid  i?  prevented  from  issuing  from  its  orifice,  and  is 
made  to  pass  backwards  by  a  refluent  action  into  the  bladder,  or  in 
some  cases  probably  is  not  permitted  to  enter  the  urethra  at  all,  on 
account  of  the  swelling  of  the  ejaculatory  and  prostatic  openings. 
This  state  may  arise  from  congestion  of  the  mucous  membrane  of  the 
urethra,  from  irritability  and  spasm  of  the  canal,  or  from  stricture. 
The  treatment  under  these  circumstances  should  be  such  as  to  remove 
the  diseased  conditions  of  the  urethra,  and  with  them,  the  effects  of 
this  form  of  impotency  would  also  disappear. 

I  have  thought  it  expedient  to  make  my  remarks  on  this  subject 
as  concise  as  possible,  and  avoid  repetition;  1  have  therefore  merely 
2B 


358  CAUSES    OF    SPERMATOEEH(EA. 

taken  a  general  view  of  the  principles  of  treatment.  Those  ■which 
apply  to  spermatorrhoea,  and  are  more  fully  detailed  in  the  chapter 
on  the  treatment  of  that  disease,  Avill  be  found  to  be  very  generally 
suitable  to  the  phenomena  of  impotency. 


CHAPTER  V. 

CAUSES    OF    SPERMATORRH(EA. 

The  knowledge  of  the  precise  cause  of  any  given  disease  is  of  the 
first  importance  to  a  proper  understanding  of  its  treatment  and  cure, 
"Where  the. phenomena  presenting  themselves  are  obscure,  and  difficult 
to  trace  to  their  proper  source,  as  in  the  case  of  spermatorrhoea,  the 
careful  investigation  of  them,  and  of  their  mutual  relations,  becomes 
an  urnrent  necessity.  Inferences  drawn  from  external  appearances 
are  frequently  the  first  and  only  guide  to  the  cause  of  the  disease. 
As  often  happens,  also,  the  indications  of  spermatorrhoea  can  only 
be  traced  to  their  true  head,  through  a  set  of  symptoms,  which,  con- 
sidered as  independent  diseases,  would  naturally  be  referred  to  a  very 
different  origin  and  lead  away  the  mind  from  the  supposition  that 
disarrangement  of  the  genital  system  was  indeed  their  primary 
origin.  Increased  difficulty  also  arises  from  the  moral  delicacy  of  the 
subject,  and  from  the  disinclination  that  most  patients  suffering  from 
this  distressing  malady  have  to  the  investigation  of  a  state  of  suffer- 
ing, which,  in  their  morbid  fancy,  is  associated  with  degradation. 

The  diseases  which  it  thus  becomes  necessary  to  look  upon  some- 
times in  the  light  of  causes  of  spermatorrhoea  occasionally  assume 
the  characters  of  cerebral  and  nervous  affections,  of  derangements 
in  the  circulating  and  digestive  systems,  of  congestions  of  various 
organs,  and  excessive  general  and  local  debility.  These  constitutional 
causes  of  the  disease  are  numerous,  and  require  judgment  in  their 
diagnosis,  from  the  difficulty  of  determining  the  relative  proportion 
of  the  symptoms  assignable  to  a  simple  disarrangement  of  the  func- 
tion of  any  particular  organ,  and  that  due  to  primary  disease  of  the 
structure  of  tiie  part. 

The  brain  and  nervous  system  are  of  all  the  organs  of  the  body 
the  most  susceptible  of  serious  morbid  changes  originating  in  this 
disease ;  and  upon  them  the  first  impression  of  disturbance  is  most 
readily  shown.  The  least  dangerous  but  at  the  same  time  the  most 
persistent  of  these  morbid  conditions,  is  simple  excitement  of  the 
brain,  developed  by  the  most  ordinary  external  circumstances,  and 
by  the  commonest  occurrences  of  daily  life.  Excitement  of  this 
kind  increases  in  importance,  in  proportion  as  the  mind  is  subjected 
for  a  longer  or  shorter  period  to  its  influence.  And  although  this 
state  must  be  considered  more  as  a  perversion  of  lieaUhy  action 
than  one  of  actual  disease,  still  it  is  better  to  endeavor   to  effect 


CAUSES    OF    SPERMATORRHCEA.  359 

its  removal  while  in  a  recent  stage,  than  to  allow  it  to  acquire  a 
firmer  hold  on  the  system.  The  symptoms  now  referred  to  depend 
on  congestion,  which,  if  permitted  to  continue,  will  eventually  in- 
crease to  a  degree  of  extreme  intensity,  and  assume  all  the  characters 
of  threatened  apoplexy.  At  other  times  the  irregular  distribution 
of  irritability  will  occasion  serious  inflammatory  attacks,  followed  by 
such  an  amount  of  exhaustion  that  the  patient  often  sinks  beneath 
their  violence  ;  and  unless  the  symptoms  be  arrested  before  tliey 
reach  this  degree  of  activity  they  are  apt  to  proceed  on  to  struc- 
tural disorganization,  and  then  admit  of  very  feeble  prospects  of 
relief. 

The  progress  of  these  psychological  conditions  may  therefore  be 
arranged  into  three  stages:  the  first,  and  simplest,  may  be  con- 
sidered as  merely  a  special  tendency  of  the  mind  to  erotic  imagi- 
nation while  sleeping  or  waking,  influencing  directly  the  generative 
system,  the  state  of  the  brain  being  healthy  ;  the  second  embraces 
the  effects  of  congestion  and  inflammation,  the  brain  being  diseased; 
while  the  third  exhibits  a  state  of  paralysis,  occasioned  by  structural 
decay.  Constitutional  effects,  therefore,  in  relation  with  the  brain 
may  arise  from  any  circumstance  sufficiently  powerful  to  excite 
that  organ  into  undue  action  ;  from  unchaste  ideas  created  by  the 
perusal  of  licentious  books ;  from  exciting  passions  ;  from  close  appli- 
cation to  study ;  from  long  continued  attention  to  business.  These 
conditions  affect  the  brain  directly,  and  bear  a  sort  of  self-evidence 
of  their  capability  to  produce  diseased  action  in  the  genital  system. 
But  there  are  other  and  more  indirect  sources  whence  the  same 
efiect  is  likely  to  arise,  such  as  violent  and  excessive  exercise,  acci- 
dental violence,  or  exposure  to  extremes  of  heat  and  cold.  The 
disease  may  in  short  be  occasioned  by  anything  that  overstrains 
the  mind,  or  by  which  the  bodily  powers  are  weakened. 

Such  states  of  excitement  can  exist  for  a  very  short  time  indeed 
without  involving  in  a  greater  or  less  degree  the  other  systems  of 
the  body  that  depend  for  their  performance  on  nervous  activity. 
One  of  the  first  among  these  to  participate  in  the  disorder  is  that 
of  digestion,  and  it  soon  beomes  necessary  to  contend  against  the 
long  train  of  symptoms  which  accompany  disorder  of  the  assimi- 
latincr  functions.  When  disarrangement  of  the  circulation,  such 
as  is  present  with  an  apoplectic  tendency,  is  added  to  these  symp- 
toms, it  may  easily  be  conceived  that  the  difiiculty  of  diagnosis  is 
indeed  seriously  complicated. 

Congenital  debility  is  sometimes,  though  by  no  means  frequently, 
a  cause  of  asthenic  spermatorrhoea.  When  such  is  the  case,  the 
malady  is  not  very  amenable  to  treatment,  but  it  occasionally  hap- 
pens that  a  careful  and  judicious  management  is  of  essential  bene- 
fit, if  not  in  entirely  removing  the  symptoms,  at  least  in  modifying 
them  to  a  great  extent,  and  thus  irapioviug  the  condition  of  the 
patient.  Even  those  that  are  apparently  the  worst  cases,  sometimes 
yield  sufficiently  to  awaken  hope  and  confidence  in  favor  of  the 
steady  pursuance  of  a  proper  course  of  treatment. 


360  CAUSES    OF    SPERMATOEEHGEA. 

The  most  frequent  local  causes  of  spermatorrhoea  are  to  be  found 
in  the  urethra.  Inflammation  seated  in  its  mucuous  membrane, 
hence  communicated  to  the  prostate  gland,  and  giving  more  or  less 
evidence  of  its  presence,  usually  precedes  the  same  condition  in  the 
vesiculce  seminales  and  testes.  Inflammatory  attacks  of  this  kind 
are  by  no  means  unfrequent,  and  arise  from  various  causes,  among 
•which  exposure  to  cold  is  not  uncommon.  In  that  state  the  mem- 
brane frequently  takes  on  a  disposition  to  active  secretion,  attended 
with  inflammation,  showing  itself  in  the  form  of  urethral  catarrh, 
in  the  way  that  cold  generally  affects  the  raucous  membrane;  and 
the  inflammatory  action  spreads  more  or  less  rapidly  to  the  other 
contiguous  structures.  This  condition  is  very  different  from  the 
urethritis  and  mucuous  discharge,  which  arise  as  a  consequence  of 
primary  irritation  of  the  seminal  organs,  occasioned  by  structural 
disease,  and  independent  of  functional  disorder. 

The  remote  causes  of  spermatorrhoea  sometimes  take  their  rise 
in  irritation  of  the  kidneys  and  bladder.  The  spread  of  inflamma- 
tion from  the  urinary  organs  is  direct,  by  virtue  of  the  continuity 
of  the  mucous  membrane,  extending  along  the  surfaces  of  the  semi- 
nal secreting  organs.  The  severity  of  the  attack  will  be  usually 
found  less  in  degree,  and  more  easily  treated,  in  proportion  to  the 
remoteness  of  the  local  exciting  cause. 

xsext  to  inflammation  of  the  kidneys  and  bladder,  and  proceeding 
from  actual  structural  disease,  as  a  cause  of  spermatorrhoea,  must 
he  arranged  irritations  excited  in  these  organs,  as  well  as  in  the 
urethra,  by  the  abuse  of  spirituous  liquors,  the  ingestion  of  certain 
articles  of  diet  and  particular  medicines.  Strong  infusions  of  tea 
and  coffee,  the  local  action  of  cantharides,  nitrate  of  potass,  and 
camphor,  naturally  occur  to  the  mind  in  considering  a  list  of  articles 
likely  to  produce  excitement  of  the  genital  organs,  by  their  local  as 
well  as  by  their  constitutional  influence  on  the  system.. 

Venereal  excesses  are  a  fertile  and  common  source  of  seminal 
disease,  but  not  exactly  proportionate  to  the  amount  of  their  indul- 
gence. It  constantly  happens  that  an  excess  which  in  some  persons 
would  occasion  only  temporary  derangement,  would  in  others  be 
sufiicient  to  establish  a  permanent  and  exhausting  discharge.  Much 
depends  upon  the  natural  excitability  of  the  constitution,  and  much 
also  upon  the  predominant  tendency  to  local  irritations.  If,  com- 
bined with  such  a  constitutional  susceptibility,  an  attack  of  go- 
norrhoea should  occur,  symptoms  of  seminal  disease  more  or  less 
complete,  seldom  fail  to  be  produced.  A  subsidence  of  the  active 
symptoms  of  the  disease  may  and  usually  does  follow  upon  the  dis- 
appearance of  the  gonorrhoea,  but  this  subsidence  must  not  be  mis- 
taken for  a  proof  of  the  complete  restoration  of  the  genital  apparatus 
to  a  state  of  health.  The  seminal  disease  requires  only  a  certain 
amount  of  irritation  to  recall  it  into  a  condition  of  activity.  Some- 
times, however,  the  apparent  subsidence  really  indicates  that  the 
disease  is  assuming  gradually  the  passive  or  asthenic  stage  ;  in  other 
words,  is  passing  into  a  state  of  rebellious  inveteracy. 


CAUSES    OF    SPERMATORRHCEA.  361 

A  condition  of  the  urethra  occasioning  stricture  of  the  canal  may 
become  an  exciting  cause  of  spermatorrhoea,  and  ^vhen  the  local  in- 
flammation attending  it  diminishes  to  the  state  usually  understood 
by  the  term  atonic,  the  abrasion  or  ulceration  Avhich  succeeds  then 
continues  to  keep  up  the  disease. 

The  prostate  gland  is  also  an  occasional  cause  of  spermatorrhoea, 
either  from  inflammation  primarily  arising  in  the  texture  of  the 
gland  itself,  or  from  diseased  action  induced  in  it  by  irritation  of 
the  urethra.  It  is  probably  not  often  a  primary  source  of  the  dis- 
ease, for  reasons  incident  to  its  situation  and  function.  When  it 
does  become  so,  the  effects  produced  on  the  gland  are  marked  by 
great  permanence,  and  long  after  irritation  of  all  the  surrounding 
organs  has  apparently  ceased,  the  prostate  seems  to  contain  within 
itself  the  elements  for  a  recommencement  of  the  spermatorrhoea. 

A  varicose  state  of  the  veins  of  the  prostate  is  also  conducive  to 
sustained  irritation  in  the  gland. 

The  rectum  is  subject  to  several  diseases,  both  of  a  mechanical 
and  structural  nature,  and  its  proximity  to  the  vesiculae  seminales 
naturally  influences  in  a  considerable  degree  the  irritations  which 
affect  those  organs.  The  close  vicinity  of  the  intestine  renders  its 
ordinary  distension,  and  the  contractions  of  the  levatores  ani  mus- 
cles, active  in  the  production  and  continuance  of  the  vesicular  form 
of  spermatorrhoea,  especially  when  the  vesicular  are  more  than 
usually  susceptible  of  irritation.  This  susceptibility  excites  the 
function  of  secretion,  and  the  pressure  or  muscular  contractions 
then  cause  an  ejection  from  the  urethra  of  a  quantity  of  transparent 
glairy  mucus,  immediately  or  soon  after  the  passage  of  the  feces. 
The  occurrence  of  this  circumstance  leads  the  patient  to  an  attentive 
examination  of  his  state,  and  he  discovers  probably  that  it  is  almost 
constant  on  going  to  stool.  To  the  medical  practitioner  this  occur- 
rence will  be  the  evidence  of  an  undue  excitement  already  com- 
menced in  the  vesiculsB,  which,  without  proper  treatment,  must  end 
in  a  permanently  diseased  action.  If  the  vesicuise  be  examined  by 
the  aid  of  the  finger  at  this  time,  they  will  be  found  unusually  tense, 
and  distended  with  secretion,  and  this  condition  is  accompanied 
with  a  sensation  of  dull,  heavy  aching  pain.  I  have  observed  that 
the  fluid  which  is  then  emitted  is  generally  thin  and  transparent. 
It  differs  materially  in  its  characters  from  urine,  for  which  it  is  liable 
to  be  mistaken,  especially  as  there  is  frequently  a  spasmodic  ex- 
pulsion of  the  last  few  drops  of  urine  from  the  bladder,  immediately 
after  the  passage  of  the  feces.  At  the  commencement  of  the  dis- 
ease, the  fluid  excreted  during  these  muscular  contractions  contains 
no  spermatozoa,  but  after  a  time,  when  the  testicles  participate  in 
the  excitement,  the  animalcules  become  numerous,  and  the  evidence 
of  spermatorrhoea  for  that  reason  more  distinct.  When  such  effects 
arise  from  simple  mechanical  disease  of  the  rectum,  they  are  gene- 
rally temporary  and  removable,  but  occasionally  sufficiently  dis- 
tressing and  weakening  to  require  careful  and  prolonged  treatment 
for  preventing  a  relapse. 


862  CAUSES    OF    SPERMATOERHCEA. 

Amono-  the  simplest  mechanical  inducements  of  irritation  are 
collections  of  fecal  matter  in  the  rectum  and  ascarides.  These, 
however,  present  no  great  difficulty  in  their  management.  A  vari- 
cose state  of  the  hpemorrhoidal  .veins,  by  causing  distension  of  the 
structures  around  the  rectum,  may  also  have  a  large  share  in  pro- 
moting the  conditions  likely  to  occasion  irritability  of  the  vesiculae, 
and  therefore  must  be  looked  upon  as  a  cause  of  spermatorrhoea. 

Diarrhoea,  acute  and  chronic,  and  dysentery,  may  also  induce 
excitement  of  the  vesiculse.  When  the  more  important  diseases  of 
the  rectum  become  the  excitants  of  spermatorrhoea,  the  treatment 
is  rendered  particularly  tedious  and  complicated,  and  the  disease 
will  depend  for  its  relief  upon  the  progress  of  the  exciting  cause. 
Those  structural  diseases  of  the  rectum  which  may  be  admitted  into 
the  list  of  causes  of  this  disease  are  tumors,  stricture,  and  scirrhus  ; 
and  it  will  be  understood  at  once  that  causes  so  persistent  offer 
almost  insurmountable  difficulties  to  successful  treatment.  Happily 
these  serious  maladies,  as  causes  of  spermatorrhoea,  are  the  excep- 
tion and  not  the  rule. 

The  position  of  the  testicles  renders  them  liable  to  accidental 
violence,  and  they  are  apt,  in  consequence,  to  take  on  sometimes  an 
inflammatory  action.  Orchitis,  or  inflammation  of  the  testicle, 
arising  from  a  blow,  from  sympathetic  action,  or  from  any  other 
cause,  readily  communicates  its  excitement  to  the  neighboring 
parts,  and  by  the  lining  membrane  of  the  vas  deferens,  directly  to 
the  vesiculffi  serainales.  Should  the  inflammation  assume  a  chronic 
character  and  continue  for  any  length  of  time,  tliere  is  danger  of 
its  exciting  the  structures  permanently,  and  thus  establishing  sper- 
matorrhoea. 

In  enumerating  the  list  of  causes  of  spermatorrhoea,  structural 
irritation  of  the  vesicula3  seminales  must  not  be  omitted,  but  a  purely 
independent  structural  excitement  is  probably  not  often  fixed  iu 
them.  When  such  is  the  case,  it  arises  in  very  few  instances  from 
actual  organic  change.  Functional  excitement,  on  the  contrary, 
occurs  more  f?equently,  and  depends  upon  the  general  irritable  con- 
dition of  the  nervous  system.  It  seldom  demands  much  attention, 
and  will  most  probably  cease  entirely  as  the  balance  of  nervous 
energy  becomes  restored. 

There  is  another  point  of  view,  however,  from  which  the  vcsiculte 
seminales  must  be  regarded  in  relation  with  spermatorrhoea,  for 
though  not  frequently  subject  to  become  the  origin,  they  are  un- 
doubtedly the  centre  around  which  all  the  diseased  actions  of  the 
generative  system  are  apt  to  congregate.  Their  structure  and  func- 
tions are  such  as  to  render  them  not  easily  liable  to  disturbance  ; 
but  for  the  same  reason,  when  really  excited  into  morbid  action  and 
disarranged,  it  is  very  difficult  to  bring  about  a  cessation  of  that 
disturbance.  When  once  sufficient  irritation  is  established  to  oc- 
casion spermatorrhoea,  then  the  disease  progresses  independently  of 
the  first  exciting  cause,    kept   up,  indeed,  by  the  participation   of 


CAUSES    OF    SPERMATOERHCEA.  363 

the  neighboring  organs  in  the  irritation.  For  this  reason  it  is  that 
spermatorrhoea  hardly  ever  admits  of  spontaneous  recovery,  when  it 
has  been  allowed  to  obtain  and  secure  a  firm  hold  upon  the  vesiculoj 
seminales. 

One  of  the  most  serious  of  all  the  causes  of  spermatorrhoea,  and 
one  which  includes  in  its  terrible  embrace  both  the  physical  power 
of  the  constitution  and  the  moral  condition  of  the  mind,  is  self-abuse. 
This  habit  is  usually  contracted  at  an  early  age,  most  frequently 
at  school,  and  at  a  time  when  the  moral  power  is  insufficient  to 
oppose  the  contagion  of  bad  example,  or  the  force  of  violent  and 
precocious  animal  passions.  Indulgence  of  this  habit  under  these 
circumstances  ought  not,  in  my  opinion,  to  be  classed  in  the  list  of 
moral  crimes,  as  too  frequently  happens,  but  rather  in  that  of  dis- 
ease. The  principal  difficulty  in  the  management  and  cure  of  this 
fatal  propensity  is  the  incapability  of  making  the  patient,  at  an 
early  age,  fully  understand  the  injurious  influence  upon  the  con- 
stitution or  its  after  effects.  It  is  not  an  easy  matter  to  convince 
him  that  he  is  pursuing  a  course  that  demands  the  very  strictest 
attention  and  counteraction  to  save  him  from  the  most  evil  conse- 
quences to  his  health.  To  him  the  necessity  for  a  strict  resistance 
is  quite  incomprehensible;  he  is  practising,  as  he  believes,  a  simple 
sensual  gratification  merely,  and  if  at  any  time  it  occurs  to  his  mind, 
that  he  is  doing  something  which  is  wrong,  the  impression  unfor- 
tunately is  so  slight  as  scarcely  to  occasion  him  a  moment's  uneasi- 
ness. He  relies,  perhaps,  on  his  capability  of  giving  up  the  habit 
at  a  later  age,  before  it  becomes  injurious  to  his  health.  In  this 
idea,  however,  he  will  find  himself  sadly  mistaken.  When  the  mind 
has  become  morbidly  directed  to  this  subject,  it  is  continually  and 
irresistibly  seeking  the  means  of  reproducing  its  pleasurable  sensa- 
tions. There  is  no  departure  from  the  idea,  every  moment  unoc- 
cupied in  bodily  exertion  is  devoted  to  erotic  fancies,  and  even  sleep 
is  not  exempt  from  the  mental  fascination.  As  the  disease  increases 
in  intensity,  the  mind  wearies  of  any  direction  but  the  one,  and 
however  much  it  may  be  distracted  for  a  short  time,  wanders  back 
unconsciously  to  its  morbid  train  of  thought.  The  expenditure  of 
nervous  energy  thus  carried  on,  rapidly  wastes  and  enervates  the 
body,  independently  of  the  destruction  of  the  function  which  sub- 
sequently follows.  It  is  not  long  under  these  circumstances  before 
permanent  irritability  becomes  established,  and  the  patient  sinks 
exhausted  by  all  the  fearful  symptoms  that  accompany  this  terrible 
condition  of  disease. 

Hufeland,  in  his  "Art  of  Prolonging  Life,"  has  so  well  and  so 
aptly  described  the  effects  of  this  habit,  as  influencing  the  duration 
of  life,  and  his  description  so  perfectly  agrees  with  my  own  obser- 
vations, that  I  have  considered  it  would  add  to  the  completeness  of 
my  work  to  introduce  his  remarks  on  the  subject  in  this  place. 

"  Of  all  the  means  of  hastening  death,  with  which  I  am  acquaint- 
ed, there  are  none  so  highly  destructive,  and  in  which  every  baneful 


064:  CAUSES    OF    SPERMATORRHCEA. 

property  is  so  much  united,  as  in  these.  None  comprehend  so  per- 
fectly all  the  four  requisites  for  that  purpose,  which  I  have  already 
laid  down  ;  and  indeed  these  melancholy  excesses  may  be  considered 
as  the  most  highly  concentrated  process  for  shortening  vital  duration. 
This  I  shall  immediately  prove. 

"  The  first  mean  of  shortening  life  was,  lessening  the  vital  power 
itself.  But  what  can  more  lessen  the  sum  of  the  vital  power  within 
us  than  wasting  those  juices  which  contain  it  in  the  most  concen- 
trated form,  as  well  as  the  first  vital  spark  for  a  new  being,  and  the 
most  powerful  balsam  for  our  own  blood  ? 

"  The  second  manner  of  shortening  life  consists  in  lessening  the 
necessary  solidity  and  elasticity  of  the  vessels  and  organs.  But  it 
is  well  known  that  nothing  tends  so  much  to  relax,  to  soften,  and  to 
corrupt,  as  this  dissipation. 

"  The  third  manner,  or  more  rapid  consumption,  can  be  promoted 
by  nothing  so  much  as  by  a  circumstance,  which,  as  appears  from 
the  example  of  all  nature,  is  the  highest  degree  of  vital  activity  ;  and 
which,  as  before  shown,  is  in  many  beings  the  conclusion  of  their 
whole  life. 

"  Lastly,  proper  restoration  is  thereby  prevented  in  an  uncommon 
degree,  because  that  rest  and  that  equilibrium  necessary  for  re- 
pairing what  has  been  lost  are  impeded,  and  the  organs  deprived  of 
the  power  requisite  for  the  same  purpose;  but,  in  particular,  because 
these  debaucheries  have  a  peculiar  weakening  effect  on  the  stomach 
and  the  lungs,  and  thereby  specifically  desiccate  the  grand  source 
of  our  restoration. 

"  To  this  may  be  added  the  danger  of  imbibing,  amid  such  irre- 
gularities, that  most  dreadful  of  poisons,  the  venereal,  against  which 
no  one  is  secure  who  has  illicit  intercourse  with  the  fair  sex — a 
poison  which  may  not  only  shorten  life,  but  render  it  also  painful, 
miserable,  and  loathsome,  and  of  which  I  shall  speak  at  more  length 
when  I  come  to  treat  on  Poisons. 

'•  I  must  here  mention  also  several  other  concomitant  circum- 
stances which  are  connected  with  this  dissipation,  and  among  these 
in  particular,  that  of  the  mental  faculties  being  weakened.  It  ap- 
pears that  between  both  these  organs,  that  of  the  soul  (the  brain), 
and  those  of  generation,  as  well  as  between  the  two  functions,  that 
of  thinking  and  that  of  generating,  the  one  spiritual,  and  the  other 
physical  creation,  there  is  a  very  intimate  connection  ;  and  that  they 
both  re(iuire  the  noblest  and  most  refined  part  of  the  vital  power. 
We  find,  therefore,  that  they  both  act  alternately  on  each  other, 
and  have  a  mutual  and  contrary  effect.  The  more  we  strain  the 
mental  faculties,  the  less  vigorous  will  be  our  power  of  generation  ; 
the  more  we  stimulate  the  generative  power  and  waste  its  juices, 
the  more  does  the  soul  lose  its  faculty  of  thought,  its  energy,  its 
acuteness,  and  its  memory.  Nothing  in  the  world  can  so  much  and 
so  irretrievably  ruin  the  brightest  mental  talents  as  excess  of  this 
kind. 


CAUSES    OF    SPERIIATORRHCEA,  365 

"  It  maj,  perhaps,  be  here  asked,  what  is  meant  by  excess  in 
pliysical  love  ?  My  answer  is,  when  either  sex  indulges  that  pas- 
sion too  early,  before  the  body  is  completely  formed — females 
before  the  age  of  eighteen,  and  males  before  that  of  twenty  ;  when 
this  enjoyment  is  too  often  and  too  violently  repeated,  which  may 
be  known  by  the  following  consequences:  lassitude,  dejection,  and 
loss  of  appetite  ;  when  one,  by  a  frequent  change  of  object  and  cir- 
cumstances, or  by  the  artificial  stimulus  of  spiceries,  heating  liquors, 
and  the  like,  excites  new  desires  and  the  relaxed  powers,  or  makes 
that  exertion  during  the  time  of  digestion  ;  and,  to  include  the 
whole  in  a  few  words,  when  one  enjoys  physical  love  without  mar- 
riage ;  for  it  is  only  under  the  matrimonial  tie,  which  excludes  the 
stimulus  of  variety,  and  directs  the  physical  propensity  to  a  higher 
moral  object,  that  this  passion  can  be  physically  refined,  that  is  to 
say,  be  rendered  salutary  and  useful. 

"  Everything  that  has  been  here  said  is  applicable,  in  an  emi- 
nent degree,  to  onanism  also  ;  for  that  forced  and  unnatural  vice 
increases,  in  an  extraordinary  manner,  the  straining  of  the  organs, 
and  the  weakening  connected  with  it ;  and  this  is  a  new  proof  of 
the  principle  I  before  laid  down,  that  nature  avenges  nothing  so 
dreadfully  as  transgressions  against  herself.  When  transgressions 
prove  mortal,  they  are  always  crimes  against  nature.  It  is,  indeed, 
highly  worthy  of  remark,  that  a  dissipation  which  seems  to  be  so 
perfectly  alike  in  all  its  parts  should,  however,  be  so  different 
in  its  consequences,  according  as  it  is  confined  to  a  natural  or 
unnatural  method  ;  and  as  I  am  acquainted  with  judicious  men  who 
cannot  be  fully  convinced  of  this  difference,  I  shall  embrace  the 
present  opportunity  of  showing  how  onanism,  in  either  sex,  does 
infinitely  more  mischief  than  natural  enjoyment.  Horrid  is  the 
impression  stamped  by  nature  on  auch  an  oflFender  !  He  is  like  a 
faded  rose,  a  tree  blasted  in  its  bloom,  a  wandering  skeleton.  All 
his  fire  and  spirit  are  deadened  by  this  detestable  vice  ;  and  nothing 
remains  but  debility,  languor,  livid  paleness,  a  withered  body,  and 
a  degraded  soul.  The  eyes  lose  their  lustre  and  strength  ;  the 
pupils  seem  sunk  ;  the  features  are  distorted  and  lengthened ;  the 
rosy  complexion  of  youth  vanishes,  and  the  visage  appears  of  a 
pale-white  leaden  color.  The  whole  body  becomes  afi:ected,  and 
sensible  of  the  slightest  impression  ;  the  muscular  power  is  lost ; 
sleep  brings  with  it  no  refreshment ;  every  movement  is  attended 
with  torture  ;  the  legs  can  no  longer  support  the  body  ;  the  hands 
tremble  ;  aching  pains  arise  in  all  the  limbs  ;  the  faculty  of  thought 
is  deranged,  and  cheerfulness  is  banished.  The  unhappy  sufferer 
speaks  little,  and  as  if  it  were  only  by  force  ;  and  all  his  former 
liveliness  of  mind  is  depressed.  A  youth  endowed  by  nature  with 
genius  and  talents  becomes  dull,  or  totally  stupid  ;  the  mind  loses 
all  taste  for  virtuous  and  exalted  ideas  ;  and  the  imagination  is 
altogether  corrupted.  The  slightest  circumstance  respecting  a 
female  is   capable  of  exciting  in  him   desire,   shame,   horror,  and 


366  CAUSES    OF    SPEKMATORKHCEA. 

repentance  ;  and  despair  of  his  evils  being  cured  renders  his  misery 
complete.  The  whole  life  of  such  a  man  is  a  continued  succession 
of  secret  reproach  ;  painful  sensations,  arising  from  the  conscious- 
ness of  having  brought  upon  himself  internal  weakness  ;  irresolution 
and  disgust  of  life  ;  and  it  need  excite  no  surprise  that  such  an 
unhappy  wretch  should  at  length  become  a  self-murderer  :  for  no 
man  is  so  much  exposed  to  suicide  as  the  onanist.  The  wasting  of 
that  which  gives  life,  excites  disgust  of  life  in  the  highest  degree, 
and  that  singular  kind  of  self-murder  par  depit  which  is  so  peculiar 
to  the  present  age.  Besides,  the  powers  of  digestion  are  destroyed; 
the  patient  is  tormented  with  flatulencies,  and  the  cramp  in  the 
stomach  ;  the  blood  becomes  corrupted ;  the  breast  is  choked  up 
with  phlegm  ;  and  eruptions  and  ulcers  in  the  skin,  a  desiccation  and 
wasting  of  the  whole  frame,  epilepsy,  asthma,  slow  fever,  debility, 
and  premature  death,  are  at  length  the  consequences. 

"  There  is  another  species  of  this  vice  which  may  be  called  moral 
onanism  ;  it  is  possible  without  bodily  pollution  ;  but  it  exhausts  in 
a  dreadful  manner  also.  I  here  allude  to  heatinfi:  and  fiUinir  the 
imagination  with  obscene  and  lascivious  ideas,  and  a  vicious  and 
habitual  propensity  to  indulge  in  such  thoughts.  This  evil  may,  at 
length,  become  a  real  disease  of  the  mind  :  the,  imagination  is  then 
totally  corrupted,  and  governs  the  whole  soul ;  nothing  is  interesting 
to  men  subject  to  it,  but  what  relates  to  lewdness;  the  slightest; 
impression  of  that  kind  excites  in  them  a  general  fervor  and  irrita- 
tion ;  their  whole  existence  is  a  continual  fever,  which  weakens  the 
more,  as  it  always  stimulates  without  gratification.  This  state 
may  be  found,  above  all,  among  voluptuaries  who  have  abandoned 
sensual  enjoyment,  but  who  endeavor,  by  such  mental  indulgence, 
to  make  themselves  amends,  without  reflecting  that  in  its  conse- 
quences it  is  almost  equally  destructive  ;  also  in  religious  celibacy, 
where  mental  onanism  can  assume  the  mask  of  fervid  devotion,  and 
conceal  itself  under  the  appearance  of  divine  rapture  and  ecstasy  ; 
and,  lastly,  among  idle  persons  of  the  other  sex,  who,  by  novels  ami 
the  like  means,  have  corrupted  their  imaginations,  and  excited  in 
them  a  propensity  which  is  not  unfrequently  honored  with  the  modish 
name  of  sensibility;  and  who,  under  a  stiff"  and  severe  outside,  indulge 
often  in  the  lewdest  and  most  dissolute  ideas. 

"  This  may  suffice  on  the  melancholy  consequences  of  such  de- 
baucheries, which  tend  not  only  to  shorten  but  to  embitter  life." 


CHAPTER  VI. 

SYMPTOMS    OF    SPERMATORRHCEA. 


The  symptoms  which  accompany  spermatorrhoea  are  numerous, 
and  present  appearances  varying  with  the  nature  of  the  structures 


SYMPTOMS    OF    SPERMATORRHCEA.  367 

involved.  These  variable  symptoms  demand  our  careful  considera- 
tion and  accurate  judgment,  for  it  is  precisely  in  the  states  of  irri- 
table action,  caused  bj  excessive  or  defective  tonicity,  that  forms 
of  disease  of  a  different  nature  simulate  each  other.  Without  an 
exact  knowledge  of  the  exciting  cause  it  is  quite  possible  to  mis- 
take them,  and  to  do  a  serious  injury  to  the  patient  by  mistaking 
them,  and  adopting  consequently  a  wrong  mode  of  treatment. 

A  patient  afflicted  with  sperraatorrhcea,  which  has  endured  for 
some  time,  presents  a  melancholy  and  dejected  appearance;  he  feels 
a  constant  desire  for  change,  as  the  mere  result  of  restlessness,  and 
he  exhibits  a  strong  disinclination  for  exertion  of  every  kind.  The 
idea  of  entering  into  and  taking  part  in  the  intercourse  of  society  is 
in  every  way  hateful  to  him.  Seclusion,  that  he  may  dwell  upon 
his  morbid  fancies,  is  the  one  object  of  his  care  ;  but  this  only  serves 
to  create  dissatisfaction  and  remorse.  He  is  incapable  of  applying 
his  mind  either  to  business  or  pleasure,  and  experiences  a  constant 
and  indefinable  dread  of  something  about  to  happen.  Even  in  the 
very  commonest  affairs  of  life  he  loses  self-confidence.  His  temper 
becomes  irritable  ;  he  has  not  unfrequently  paroxysms  of  the  most 
ungovernable  rage,  occasionally  without  a  shadow  of  reason.  Con- 
tradiction of  his  opinions,  or  a  doubt  of  their  irrefragibility,  causes 
him  sudden  attacks  of  angry  violence.  He  suffers  much  from  fa- 
tigue and  lassitude,  aching  in  the  loins,  and  general  muscular  de- 
bility, especially  of  the  lower  limbs.  The  surface  loses  its  healthy 
color,  the  skin  assumes  a  muddy  appearance,  the  eyes  become 
dull  and  sunken,  and  surrounded  by  a  dark  halo ;  his  digestion  soon 
gets  thoroughly  out  of  order,  the  appetite  assuming  a  remarkable 
degree  of  capriciousness,  selecting  the  most  crude  and  indigestible 
articles  of  diet,  and  rejecting  tiie  most  simple  and  delicate  food. 

It  is  requisite  to  consider  the  symptoms  of  spermatorrhoea  both 
as  to  their  constitutional  or  functional  and  their  local  effects  on  the 
system.  While  a  sthenic  condition  of  the  disease  prevails,  and  is 
attended  with  nocturnal  emissions,  if  those  emissions  arise  simply 
from  a  plethoric  condition  of  the  seminal  tubes,  they  occasion  at 
first  no  ill  effects  to  the  patient.  When,  however,  the  state  of  ex- 
citement disappears,  that  of  atony  succeeds,  and  the  disease  then 
gradually  unfolds  itself,  altering  in  the  first  instance  the  functional 
characters  of  the  separate  organs  of  the  generative  system,  and 
then  extending  its  mischievous  and  dangerous  influence  more^ene- 
rally  through  the  constitution. 

When  a  function  so  important  as  that  of  generation  becomes  ex- 
cited into  extreme  and  uncontrollable  activity,  it  will  not  be  matter 
of  surprise  that  the  vital  power  should  be  drawn  away  from  the 
other  equally  necessary  but  less  independent  systems.  The  evil 
consequences  to  the  latter  soon  become  manifest,  and  great  organic 
and  constitutional  disturbance  folloAvs. 

The  function  which  suffers  soonest  from  the  drain  on  the  system 
is  that  of  the  brain  and  nerves,  but  it   is   not  long  before  the  heart 


368  SYMPTOMS    OF    SPERMATORKHCEA. 

and  stomach  sympathize  in  the  derangement,  and  evince  their  parti- 
cipation by  several  serious  and  ahirming  symptoms. 

The  affections  of  the  brain  which  make  their  appearance,  and 
result  from  the  disturbance  that  has  been  set  up  in  that  organ  are 
indicated  by  giddiness  and  headache,  the  latter  being  principally 
referable  to  the  cerebellar  region.  The  power  of  commanding 
and  controlling  the  ideas  is  lost,  and  much  difficulty  is  experienced 
in  recalling  the  most  familiar  subjects  of  memory.  There  is  also 
considerable  wakefulness,  which  terminates  in  general  and  extreme 
physical  exhaustion. 

If  there  be  hereditary  tendency  to  mental  derangement,  it  fre- 
quentl}'  happens  that  the  cerebral  excitement  occasioned  by  sperma- 
torhcEa  is  sufficient  to  cause  its  development.  Even  where  there  is 
no  such  tendency,  the  overwhelming  influence  of  long  continued 
cerebral  excitement,  combined  with  the  disarrangement  of  the  diges- 
tive and  secerning  systems,  is  apt  to  induce  hypochondriasis  or  some 
form  of  monomania. 

In  conjunction  with  these  indications  of  nervous  irritability  the 
heart  participates  more  or  less  quickly,  furnishing 'unmistakable 
signs  of  sympathetic  irritation  by  frequent  and  long  continued  pal- 
pitations. The  circulation  undergoes  various  changes,  giving,  in 
the  early  conditions  of  the  disease,  evidences  of  congestion  ;  in  the 
advanced  stages  showing  the  effects  of  exhausting  influences,  as 
fainting  and  general  antemia.  When  the  plethoric  states  predomi- 
nate, the  symptoms  occasionally  present  a  very  severe  character, 
and  assume  so  completely  the  appearance  of  apoplexy  as  to  cause 
anxiety  for  the  life  of  the  patient.  Irritability  of  nervous  power, 
rather  than  fulness  of  blood,  must  however  be  referred  to  as  occa- 
sioning these  results.  The  diagnosis,  therefore,  naturally  offers 
many  difficulties,  not  merely  on  account  of  the  peculiarities  of  the 
disease  itself,  but  also  from  the  fact  of  the  symptoms  leading  away 
to  all  appearance  from  the  actual  cause. 

Under  circumstances  of  such  constitutional  disarrangement,  it 
cannot  be  supposed  that  digestion  will  be  properly  performed. 
The  digestive  power  becomes  too  feeble  to  assimihite  sufficient  nou- 
rishment to  preserve  the  strength  and  the  bulk  of  the  body,  and  a  gra- 
dual and  progressive  emaciation  sets  in.  The  epigastrium  becomes 
tender  to  the  touch,  and  this  symptom  is  accompanied  with  flatu- 
lence, distension,  and  spermatic  pains  ;  and  all  the  complicated 
phenomena  of  dyspepsia  are  very  soon  established.  There  is  a 
tendency  besides  to  local  congestion  of  the  viscera  of  the  abdomen, 
and  the  action  of  the  bowels  is  apt  to  become  irregular,  at  one  time 
being  obstinately  constipated,  at  another  thrown  into  a  state  of  ex- 
citement by  a  debilitating  diarrhoea. 

The  local  sjmiptoms  of  spermatorrhoea  present  many  very  apparent 
anomalies  having  reference  to  the  structural  and  functional  pecu- 
liarities of  the  several  portions  of  the  apparatus  Avhich  happens  to 
be  affected.  Neither  must  the  effect  of  temperament  be  omitted  : 
for  some  of  the  more  important  symptoms  of  this  disease  depend 


SYMPTOMS    OF    SPERMATOREHCEA.  369 

probably  as  much  upon  tbe  temperament  of  the  individual,  as  upon 
any  other  cause  for  their  continuance.  These  symptoms  also  are 
modified  in  their  forms  by  the  sthenic  or  asthenic  condition  of  the 
organs  affected.  One  of  the  earliest  symptoms  of  the  complaint  is 
frequent  erection  with  nocturnal  emissions.  This  state  so  nearly 
approaches  to  simple  plethora,  such  as  may  exist  in  a  healthy  con- 
dition of  the  organs,  as  scarcely  to  attract  attention,  except  in  so 
far  as  by  its  constant  repetition  it  leads  on  to  the  more  decidedly 
morbid  stages. 

Voluptuous  ideas  are  constantly  recurring  in  this  excited  condi- 
tion of  the  organs,  which  no  watchfulness  or  effort  of  the  mind  is 
capable  of  banishing  entirely,  and  emissions  as  constantly  follow 
after  every  such  cerebral  excitement,  albeit  slight  in  degree.  When 
this  condition  has  become  permanent,  the  patient  is  alarmed  at 
finding  that  his  capabilities  are  inferior  to  his  desires  ;  in  fact  that 
there  is  an  unaccountable  debility  of  the  genital  organs  at  the 
moment  when  he  might  have  imagined  his  power  to  be  greatest. 
This  frequently  is  the  symptom  which  first  arouses  in  his  mind  the 
»idea  that  there  must  be  some  serious  change  taking  place  in  his 
constitution. 

Along  with  symptoms  of  this  kind  there  occurs  one  which  I  have 
remarked  to  be  very  distinctive  of  vesicular  and  prostatic  irritation, 
and  one  which  will  be  found  present  in  almost  every  patient  in 
whom  sthenic  spermatorrhoea  exists.  It  is  that  during  coitus  there 
occurs  a  sensation  of  burning  and  smarting,  as  the  semen  escapes 
into  the  urethra.  This  sensation,  though  a  marked  symptom  of  the 
disease,  is  nevertheless  favorable,  when  considered  in  relation  to 
treatment,  as  it  is  rarely  experienced  when  the  asthenic  state  has 
become  confirmed.  It  probably  arises  from  an  inflamed  and  sensi- 
tive condition  of  that  portion  of  the  urethra  situated  around  the 
openings  of  the  ducts,  and  its  intensity  is  usually  an  evidence  of 
the  actual  amount  of  inflammation  in  the  diseased  organs. 

After  a  continuance  of  the  disease  for  some  time,  the  emissions 
not  only  increase  in  number  during  the  night,  but  begin  to  make 
their  appearance  also  in  the  day,  giving  rise  to  the  diurnal  emis- 
sions of  Lallemand.  The  patient  experiences  a  sensation  of  weight 
and  fulness  in  the  rectum,  with  a  tendency  to  bearing  down  at  the 
anus.  There  is  a  good  deal  of  muscular  contraction  on  the  passage 
of  feces  ;  and  during  or  immediately  after  these  contractions,  there 
will  be  observed  an  occasional  involuntary  escape  of  seminal  secre- 
tion. This  state  of  excitement  gradually  increases,  until  the  pa- 
tient rarely  goes  to  stool  without  suffering  a  more  or  less  abundant 
emission,  and  as  the  disease  progresses,  the  excitement  of  riding 
or  walking  alone  is  sufficient  to  bring  on  the  same  occurrence.  As 
the  disease  advances  further  the  erections  cease  ;  though  there  still 
exists  an  irritable  condition  of  the  vesicultB  seminales,  with  atony 
of  the  ejaculatory  and  prostatic  duct.  The  consequences  of  this 
atony  is,  that  from  the  patent  orifices  ©f  the  ejaculatory  ducts  the 
secretion  of  the  seminal  organs  is  constantly  oozing.      This  loss 


370  SYMPTOMS    OF    SPEKMATOREHCEA. 

acts  with  fearful  effect  upon  the  constitution,  the  mental  and  bodily 
powers  diminish  rapidly,  and  the  most  alarming  exhaustion  becomes 
estnblished. 

The  list  of  local  symptoms  that  attend  on  a  confirmed  case  of 
spermatorrhoea  can  hardly  be  complete  without  including  within  it 
certain  disarrangements  that  take  place  in  the  kidneys  and  bladder, 
but  which,  though  attendant  upon  the  disease,  may  not  perhaps  be 
considered  as  exclusively  resulting  from  it.  These  ill  effects  do 
however  occur  sufficiently  often  to  render  it  necessary  to  include 
them  in  the  description  of  its  symptoms.  They  consist  of  a  general 
excitement  of  the  kidneys,  causing  them  to  pour  out  a  considerable 
quantity  of  thick,  muddy,  unhealthy  urine  ;  and  an  irritability  of 
the  bladder,  including  a  frequent  desire  to  micturate,  accompanied 
with  heat  and  pain  in  the  urethra.  The  frequent  desire  to  pass 
the  urine  becomes  exceedingly  troublesome,  after  the  symptoms 
have  endured  for  a  short  time,  especially  during  the  night.  Pa- 
tients are  accustomed  to  refer  these  attacks  to  exposure  to  cold. 

In  a  well'maikcd  case  of  spermatorrhoea,  the  urine  submitted  to 
examination  presented  the  following  characters  :  Reaction  neutral,* 
appearance  thick  and  muddy,  specific  gravity  1.23.  Having  been 
allowed  to  stand  for  some  time,  a  considerable  flocculent  mucous 
deposit  subsided  to  the  bottom,  carrying  with  it  granular  urate  of 
ammonia,  with  some  crystals  of  uric  acid.  A  film,  which  spread 
over  the  surface  of  the  fluid,  contained  stollne  of  the  urate  of  am- 
monia, with  some  dispersed  crystals  of  triple  phosphate,  or  ammo- 
niophosphate  of  lime.  The  color  of  the  urine,  after  deposition  of 
the  sediment,  was  light  brown.  On  the  addition  of  nitric  acid  and 
subsequent  evaporation,  a  large  quantity  of  nitrate  of  urea  was  ob- 
tained. In  other  cases  of  spermatorrhoea  in  which  I  have  made  an 
analysis  of  the  urine,  the  contained  salts  consisted  entirely  of  phos- 
phates. The  urine  in  most  of  these  cases  had  a  disagreeable  odor, 
and  became  rapidly  putrid. 

Symptoms  such  as  these  I  have  enumerated,  are  seldom  met  with 
in  practice  separately,  and  it  is  not  often  that  wc  have  to  contend 
with  them  in  any  large  proportion.  When,  however,  they  do  come 
before  us  in  large  number,  we  must  do  our  best  to  trace  them  to  their 
source,  and  determine,  if  possible,  the  causa  causarum,  for  our 
guidance  to  the  attainment  of  cuie.  On  a  correct  diagnosis  our 
success  in  treatment  must  necessarily  rest. 


CHAPTER   VII. 

TREATMENT    OF    SPERMATORRHCEA. 


The  treatment  of  spermatorrhoea  is  deserving  of  our  most  careful 
attention,  and  is  in  reality»the  sole  object  to  be  accomplished  by  a 


I 


TREATMENT    OF    SPERMATORRHCEA.  371 

Study  of  the  phenomena  of  the  disease.  The  scheme  of  chissification 
proposed  in  the  third  chapter  of  this  Essay  sufficiently  exposes  the 
error  of  attempting  to  treat  the  disease  with  specifics,  since  it  wouhl 
be  more  than  absurd  to  attempt  the  removal  of  symptoms  arisint^ 
from  causes  so  diverse,  by  one  uniform  mode  of  treatment,  however 
great  its  excellencies. 

The  observation  of  Lalleraand,  that  "the  discovery  of  the  sus- 
taining cause  of  spermatorrhoea  is  of  more  importance  than  the  pri- 
mary one  with  respect  to  treatment,"  deserves  consideration  in  one 
point  of  view,  namely,  in  that  which  seeks  to  accomplish  the  purpose 
of  curing  the  disease  without  ascertaining  the  principles  by  which 
the  cure  is  to  be  eff"ected.  The  idea  will,  of  course,  bear  greater 
proportionate  weight  with  those  who  consider  spermatorrhoea  as  con- 
sisting always  of  a  more  or  less  violent  aff'ection  of  the  entire  of  one 
set  of  structures.  It  must,  however,  at  the  same  time  be  admitted, 
that  a  knowledge  of  the  particular  structure  in  which  the  immediate 
symptoms  originate,  might  furnish  us  with  a  very  useful  indication 
as  to  the  peculiar  influence  and  direction  of  the  sustaining  cause. 

A  plan  of  treatment  worthy  of  adoption  should  have  a  due  regard 
to  the  active  or  passive  condition  of  the  parts  affected,  not  merely 
so  far  as  those  conditions  may  be  the  evidences  of  disease,  but  also 
in  respect  of  their  relation  to  the  natural  performance  of  their  ac- 
customed functions.  In  the  one  instance,  the  remedies  employed 
should  be  competent  to  subdue  action  ;  in  the  other,  they  should  be 
calculated,  eithjer  by  direct  stimulation  or  counter-irritation,  to  pro- 
mote a  condition  of  reaction  in  the  affected  parts  akin  to  a  state  of 
health.  Our  chief  endeavor  should  undoubtedly  be,  to  remove  the 
cause  of  the  morbid  symptoms;  but  we  must  also  consider  that  there 
is  usually  a  remote,  as  well  as  a  sustaining  cause,  on  which  the  per- 
sistence of  those  symptoms  may  depend.  The  prognosis  of  sper- 
matorrhoea is  not  easy.  The  development  of  the  disease  will  be 
rapid,  and  its  duration  long,  in  proportion  to  the  amount  of  natural 
constitutional  excitement,  and  the  tendency  of  the  system  to  local 
irritations.  The  results  may  depend  materially  on  the  natural  powers 
of  the  constitution. 

I  do  not  intend  entering  on  the  question  of  the  applicability  of 
Lallemand's  treatment  of  cauterization,  to  the  various  forms  of  the 
disease,  as  arranged  in  my  table  under  their  proper  heads.  It 
would  appear,  however,  that  in  many  of  his  cases  the  treatment 
which  he  has  pointed  out  as  next  to  specific  in  theory,  was  frequently 
unsuccessful  in  practice,  and  certainly  does  not  favor  the  infalli- 
bility of  discovering  and  acting  upon  the  sustaining  cause  alone. 
The  treatment  by  cauterization  proves  of  the  most  essential  service 
where  its  employment  produces  the  effect  of  a  sufficiently  extended 
counter-irritation.  It  is  particularly  serviceable  in  subacute  inflam- 
mation of  the  vesicular  seminales  and  testicle.  It  may  be  used  also 
with  much  advantage  in  those  atonic  states  of  the  openings  of  the 
prostatic  and  ejaculatory  ducts,  where  there   is  a  constant   oozing 


372  TEEATMENT    OF    SPEEMATOEKHCEA. 

away  of  spermatic  fluid.  The  effect  in  such  cases  is  a  certain  degree 
of  inflammation,  sometimes  attended  with  an  escape  of  blood;  and 
when  this  inflammation  subsides,  it  frequently  happens  that  the  pri- 
mary excitement  of  the  organs  is  also  subdued. 

Lallemand  has  stated,  that  the  application  of  nitrate  of  silver  acts 
only  specifically  when  it  is  brought  in  substance  into  direct  contact 
with  the  openings  of  the  prostatic  and  ejaculatory  ducts,  and  that 
the  same  benefit  has  not  been  obtained  by  its  application  in  the 
form  of  injection.  The  latter  circumstance  arises,  I  believe,  merely 
from  the  fact  of  its  force  being  expended  on  the  mucous  membrane 
of  the  urethra,  and  not  being  applied  directly  to  the  diseased  spot. 
A  careful  application  of  the  solution  immediately  to  the  part  aff"ected 
may  be  made  to  produce  an  equivalent  benefit,  without  risking 
the  serious  effects  which  sometimes  arise  from  the  contact  of  the 
solid  caustic  with  the  urethra.  I  am  in  the  habit  of  applying  a 
strong  solution  of  the  nitrate  to  any  single  part  of  the  canal  by  using 
a  curved  glass  syringe,  a  catheter  in  fact  with  an  opening  on  the 
back  of  the  curve,  near  its  extremity,  the  instrument  having  a  small 
globe  of  India  rubber  attached  to  its  external  end.  Tiie  opening 
is  made  to  pass  over  every  part  to  which  it  is  required  to  apply  the 
caustic  solution,  and  a  slight  pressure  kept  up  on  the  India  rubber 
globe  always  brings  a  fresh  quantity  of  the  solution  to  the  opening. 
Wherever  the  solution  comes  in  contact  with  the  mucous  membrane 
the  nitrate  will  be  almost  immediately  decomposed,  and  no  longer 
liable  to  produce  irritation. 

The  mode  of  applying  the  caustic  has  certainly  very  much  to  do 
■with  its  success,  and  is  the  reason  probably  that  there  have  been  so 
many  failures  in  its  employment.  When  used  too  freely  to  the  irri- 
table mucous  membrane  in  the  neighborhood  of  the  disease,  it  is 
liable  to  occasion  excessive  action  with  severe  pain,  and  sometimes 
lays  the  foundation  for  ulceration.  This  might  naturally  be  anti- 
cipated from  the  known  high  degree  of  sensitiveness  which  renders 
the  membrane  so  liable  to  irritation.  Such  irritation  is  generally 
an  evidence  of  the  degree  of  diseased  activity  in  cases  of  sperma- 
torrhoea. In  whatever  form,  however,  the  nitrate  is  applied,  the 
object  to  accomplish,  is  just  such  an  amount  of  action  as  to  induce 
counter-irritation,  without  occasioning  abrasion  and  ulceration.  On 
the  other  hand,  an  insufficient  application  of  the  caustic  simply 
increases  the  existing  inflammation,  without  efifecting  any  good 
purpose. 

The  simple  introduction  of  a  catheter  is  also  at  times  very 
serviceable,  apparently  from  producing,  though  to  a  less  extent,  a 
certain  amount  of  counter-irritation  in  the  neighborhood  of  the 
openings  of  the  ducts.  The  pain  occasioned  by  the  introduction  of 
a  catheter  was  taken  by  Lallemand  as  the  test  of  the  necessity  for 
the  use  of  the  caustic. 

The  application  of  cold  of  a  sufficient  intensity  and  prolonged 
duration  is  often  of  great  advantage,  and  when  the  disease  depends 


TREATMENT    OF    SPERMATORRHCEA .  373 

on  irritation  of  the  testicle,  can  easil}''  be  managed.  There  is  much 
diiBculty  in  applying  cold  of  a  proper  degree  of  intensity  in  irritation 
of  the  vesiculaa,  on  account  of  the  depth  in  the  perineum  at  which 
those  organs  are  situated.  Cold  may  also  be  used  as  a  stimulant, 
through  its  power  of  inducing  reaction  after  a  short  application. 
Thus,  it  is  evident  that  cold  may  be  made  useful  in  two  very  diiierent 
conditions  of  the  organs,  but  a  previous  discrimination  of  the  cause 
of  the  disease  is  absolutely  necessary  for  its  eifective  employment. 
For  this  reason,  cold  baths  and  douches  are  sometimes  efficacious  in 
affording  relief,  and  at  other  times  increase  the  disease  materially. 
The  same  observations  are  applicable  to  the  use  of  hot  and  medi- 
cated baths.  It  sometimes  happens  that  the  most  desirable  results 
are  produced  by  their  use,  while,  on  the  other  hand,  it  occasionally 
chances  that  the  symptoms  are  not  only  not  improved,  but  arc 
greatly  aggravated. 

Whenever  there  are  evident  proofs  of  local  inflammation,  benefit 
is  often  obtained  by  the  application  of  leeches,  and  also  by  cupping. 
The  good  effects  of  the  abstraction  of  blood  are,  however,  too  fre- 
quently fugitive ;  indeed,  are  generally  so,  unless  followed  up  by  an 
active  constitutional  treatment. 

Blisters  to  the  perineum  occasionally  prove  very  serviceable,  and 
in  proportion  apparently  to  the  intensity  of  the  inflammation  which 
they  excite,  and  the  amount  of  serous  effusion  which  follows  their 
application.  The  objection  raised  against  them  of  inducing  stran- 
gury, can  seldom  be  fairly  made,  when  they  are  used  with  care,  and 
removed  immediately  after  sufficient  irritation  has  been  effected  to 
cause  a  plentiful  discharge  of  serum.  A  piece  of  muslin,  interposed 
between  the  surface  of  a  blister  and  the  skin,  is  generally  all  that  is 
necessary  to  prevent  this  accident  from  occurring. 

When  these  remedies  have  failed  to  effect  a  cure,  a  still  more 
severe  treatment  may  be  employed  for  the  purpose  of  accomplishing 
this  desirable  object,  namely,  the  insertion  of  an  issue  or  seton  in 
the  perineum.  In  the  case  related  in  the  first  chapter  of  this 
treatise,  this  plan  succeeded  perfectly.  The  formation  of  an  issue 
by  transfixing  a  fold  of  skin  in  the  perineum  by  a  bistoury,  is  not  a 
very  painful  operation,  and  is  far  from  being  difficult  to  perform. 
It  may,  however,  be  considered  as  one  of  the  most  effectual  means 
of  local'  treatment,  on  account  of  the  extensive  and  permanent 
counter-irritation  which  is  excited.  This  proceeding  must  not,  how- 
ever, be  put  in  practice  without  great  caution,  and  it  is  necessary  to 
determine  correctly  beforehand  Avhether  the  condition  of  the  parts 
affected  is  asthenic  or  sthenic. 

Previously  to  entering  upon  the  general  constitutional  treatment 
of  spermatorrhoea  it  may  be  as  well  to  examine  into  the  effects  of 
certain  medicines,  which,  taken  internally,  pass  into  the  blood,  and 
appear  to  exert  a  kind  of  specific  influence  upon  the  urethra  and  its 
surrounding  structures.  The  applicability  of  the  peculiar  properties 
of  these  medicines  to  different  forms  of  the  disease  has  naturally 
24 


374  TREATMENT    OF    SPEEM ATORRHCEA. 

given  them  a  right  to  be  fully  considered  in  any  system  of  treatment 
to  be  recommended  for  spermatorrhoea. 

The  ergot  of  rye,  or  spurred  rye,  has  a  remarkable  influence  on 
the  organs  of  generation,  and  renders  valuable  service  in  the  treat- 
ment of  their  diseases.  Of  all  the  classes  of  remedies  having  a 
power  of  local  determination  to  these  organs  it  has  certainly  in  my 
hands  appeared  to  effect  the  greatest  amount  of  good.  It  must  not, 
however,  be  used  indiscriminately  and  in  every  form  of  the  disease, 
but  only  in  those  states  Avhich  are  associated  with  an  asthenic 
condition.  In  these  cases  it  seems  to  have  a  specific  action  of  its 
own,  in  restoring  permanently  the  functions  of  the  generative  system, 
and  in  relieving  the  peculiar  atony  which,  in  the  cases  referred  to, 
pervades  these  structures.  The  forms  in  which  I  have  been  in  the 
habit  of  prescribing  it  are  a  spirituous  extract  made  into  pills,  and 
an  infusion  of  the  powdered  grains  with  camphor.  The  former  of 
these  two  preparations  is  the  most  convenient,  but  I  have  not  always 
found  it  so  eifective  as  the  latter. 

Camphor  has  a  great  efiect  in  subduing  excitation  of  the  urinary 
organs,  and  occasionally  proves  of  much  service  where  the  disease 
is  accompanied  with  irritation  of  the  kidneys  and  bladder ;  but,  like 
the  ergot,  it  is  a  remedy  which  does  not  admit  of  indiscriminate  use. 
Copaiba,  turpentine,  and  the  oleo-resins,  are  other  useful  aids,  but 
their  employment  also  requires  limitation,  and  they  are  probably 
most  suitable  where  the  disease  has  originated  in  syphilitic  irritation 
of  the  raucous  membrane  of  the  urethra. 

Many  objections  have  been  raised  against  tlie  use  of  cantharides 
in  this  disease,  some  even  contending  that  as  an  internal  remedy  it 
should  be  totally  abandoned  ;  but  I  do  not  give  my  assent  to  this 
opinion  without  further  consideration  of  the  matter.  In  the  atonic 
forms  of  the  disease  its  use  is  often  advantageous,  and  it  certainly 
has  a  special  influence  over  the  bladder  and  urethra  that  no  other 
medicine  possesses  ;  but  like,  and  perhaps  more  than  all  other  reme- 
dies, it  requires  that  the  particular  cases  to  which  it  is  applicable 
should  be  distinctly  ascertained. 

When,  as  sometimes  happens,  the  inflammatory  conditions  of  the 
organs  are  attended  with  pain,  especially  when  the  exciting  cause  is 
referable  to  the  bladder,  sedatives  may  be  administered  with  advan- 
tage. The  best  sedative  for  the  purpose  is  hyoscyamus,  because  it 
has  no  tendency  to  confine  the  bowels,  and  because  its  employment 
is  unattended  with  the  excitement  which  follows  the  exhibition  of 
opium  ;  for  this  reason  it  is  also  preferable  to  most  other  narcotics. 
The  addition  of  a  small  quantity  of  ipecacuanha,  by  arresting  in 
some  degreee  the  rapidity  of  the  circulation,  renders  a  smaller  por- 
tion of  the  sedative  capable  of  producing  the  desired  eff'ect. 

Occasionally  the  pain  increases  to  such  an  extent,  and  appears  to 
be  so  slightly  controlled  by  constitutional  means,  as  to  require  a 
local  application.  Under  these  circumstances,  the  inunction  of  vera- 
trine  and  belladonna  to  the  perineum  has  often  the  eftect  of  subduing 


TREATMENT    OF    SPERMATOREHCEA,  375 

action  and  relieving  pain,  when  other  modes  of  treatment  have  proved 
unavailing. 

Gallic  acid  and  tannin,  on  account  of  their  power  of  arrestinrr  ex- 
cessive mucous  secretion,  are  useful  remedies  in  this  disease,  and 
can  be  employed  to  produce  their  effects  constitutionally  or  by  local 
application. 

I  must  not  pass  over  another  local  remedy,  namely,  acupuncture, 
without  a  remark,  since  it  has  been  highly  extolled  and  recommended 
by  Lallemand  for  the  relief  of  spermatorrhoea.  I  have  had  the 
opportunity  of  applying  it  in  two  cases  only,  but  in  both  v/ithout 
success.  Lallemand's  plan  consists  in  transfixing  the  prostate  gland 
with  one  or  two  fine  long  needles,  the  stimulus  excited  by  their  pre- 
sence being  intended  to  relieve  the  morbidly  irritated  portions  of  the 
genital  apparatus,  as  in  other  forms  of  counter-irritation. 

From  the  list  of  remedies  I  have  here  detailed,  the  principle  of 
treatment  will  be  distinctly  perceived.  There  are,  of  course,  prac- 
tical suggestions  that  will  arise,  and  present  us  with  reasons  for 
modification,  in  every  case,  and  by  these  v/e  must  be  guided  in  our 
selection  of  the  most  appropriate  plan. 

The  same  general  observation  bears  a  more  important  application 
in  the  management  of  the  constitutional  evidences  of  the  disease. 
To  the  different  kinds  of  spermatorrhoea,  excitement  of  the  brain  and 
nervous  system  contributes  a  very  serious  complication.  Symptoms 
of  this  nature  require  to  be  treated  by  the  avoidance  of  all  stimulat- 
ing food,  by  following  a  cooling  regimen,  and  paying  careful  atten- 
tion to  the  bowels.  When  the  nervous  disorder  arises  from  a  reaction 
of  the  excitement  of  the  generative  system  on  the  brain,  it  will  be 
necessary  to  adopt  local,  in  addition  to  constitutional,  measures.  A 
morbid  condition  of  the  brain  is  sometimes  established,  which  de- 
pends for  its  continuance  on  the  accumulation  of  a  large  amount  of 
nervous  irritability.  This  may  be  relieved  most  effectually  by  in- 
creased natural  stimulus  given  to  the  mind,  the  direction  of  the 
thoughts  being  turned  into  a  train  different  from  its  ordinary  course  ; 
or,  better  still,  by  the  occupation  of  vital  force  in  active  muscular 
exertion. 

The  circulating  system  in  cases  of  spermatorrhoea  demands  much 
attention,  as  many  grave  symptoms  indicating  serious  disturbance 
of  the  heart  and  large  vessels  are  apt  to  arise.  These  attacks,  though 
depending  essentially  upon  the  progress  and  activity  of  the  original 
disease,  nevertheless  place  the  life  of  the  patient  in  jeopardy  by  their 
own  peculiar  violence.  Symptoms  of  this  kind  appear  to  be  of  so 
much  vital  importance,  and  it  is  so  difficult  to  separate  them  from 
the  supposition  of  structural  disease  of  the  parts  affected,  that  they 
are  very  likely  to  deceive  both  patient  and  physician,  as  to  the  true 
point  whence  they  take  their  origin.  If  the  patient  should  be  of  a 
full  plethoric  habit,  with  a  tendency  to  cerebral  attacks,  it  will  be 
expedient  to  remove  blood,  in  quantity  proportioned  to  his  general 
powers  or  the  activity  of  the  disease.     This,  however,  must  be  done 


876  TREATMENT    OF    SPERMATORRHffiA. 

■with  caution,  as  the  symptoms  occasioned  by  irritable  nervous  action, 
resulting  from  excitement  of  the  genital  organs,  resemble,  in  a  re- 
markable degree,  those  produced  by  an  entirely  different  cause.  As 
a  general  rule,  instead  of  diminishing  power  by  abstracting  blood, 
the  opposite  course  must  be  pursued,  of  supporting  the  constitution, 
and  enabling  it  to  meet  the  constant  drain  upon  its  vital  resources. 

The  digestive  function  is  extremely  sensitive  to  exhausting  influ- 
ences existing  in  the  system.  In  the  early  stages  of  spermatorrhoea, 
when  the  symptoms  indicate  plethora  of  the  testicles  and  vesiculiB 
seminales,  the  unloading  of  these  organs  by  emission  of  their  secre- 
tions tends  to  increase  the  appetite  and  promote  activity  in  the  per- 
formance of  digestion.  If  this  mode  of  relief  be  too  often  repeated, 
it  induces  an  opposite  efl'ect  on  the  system,  namely,  irritability  of  the 
stomach.  This  organ  becomes  incapable  of  retaining  sufficient  food 
for  the  necessities  of  nutrition,  and  the  power  of  assimilation  is  also 
lessened.  It  then  naturally  follows  that  the  strength  and  substance 
of  the  body  waste  with  rapidity. 

The  remedial  indication,  in  such  a  condition  as  that  I  am  now 
describing,  is  to  corroborate  the  constitution  by  tonic  medicines, 
such  as  quinine,  gentian,  the  mineral  acids,  steel,  and  to  these  may 
be  added  a  regulated  use  of  ordinary  dietetic  stimulants.  A  strict 
regimen  should  be  enforced,  but  with  a  reasonable  amount  of  light 
and  digestible  food.  Care  must,  however,  be  taken  to  avoid  the 
use  of  spices,  and  of  everything  likely  to  irritate  the  stomach  or 
occasion  indigestion.  An  excellent  means  of  supporting  the  con- 
stitution under  the  emaciation  that  usually  follows  an  attack  of  this 
disease  is  presented  to  us  in  a  medico-alimentary  substance,  which 
•  has  of  late  years  come  much  into  favor,  namely,  cod-liver  oil. 
Probably  no  dietetic  preparation  could  be  proposed  more  likely  to 
be  serviceable  in  spermatorrhoea.  The  oil  is  not  admitted  into  the 
treatment  with  any  supposed  special  medicinal  quality,  but  offers 
us  a  concentrated  article  of  diet  as  a  means  of  nourishment  superior 
to  most  others  we  are  in  the  habit  of  using.  It  should  be  taken 
directly  after  a  meal,  twice  or  thrice  a  day.  In  this  way  it  will  be 
brought  in  contact  with  the  absorbing  and  assimilating  apparatus, 
when  in  their  most  active  conditions.  It  is  readily  absorbed  into 
the  system,  and  rapidly  supplies  the  wasting  body  with  nourish- 
ment. 

The  chief  objection  which  may  be  raised  against  cod-liver  oil  is  its 
aptness  to  occasion  nausea,  a  circumstance  which  arises  partly  from 
the  weakened  powers  of  digestion,  and  partly  from  the  large  quantity 
usually  thought  necessary  to  be  administered.  The  objections  to 
this  remedy  are,  in  many  instances,  got  over  by  a  preparation  which 
I  have  found  of  great  value,  namely,  the  cod-liver  oil  of  chocolate. 
It  is  composed  of  the  purest  oil,  carefully  combined  with  chocolate 
in  its  most  agreeable  shape.  To  cover  the  odor  and  taste  of  the  oil 
as  completely  as  possible,  various  essential  oils  can  be  added  to  the 
chocolate,   by  which  means  it   becomes  a  pleasant  article  of  diet. 


TREATMENT    OF    SPERMATOKEHCEA.  377 

Prepared  in  this  -u-ay,  the  oil  is  much  less  likely  to  occasion  nausea, 
or  otherwise  to  interfere  with  the  delicate  digestion  that  patients 
suftering  from  spermatorrhoea  are  so  liable  to  experience.  The 
division  of  the  particles  of  the  oil  by  chocolate,  itself  a  highly 
nourishing  substance,  renders  the  compound  very  easy  of  assimila- 
tion by  the  system. 

It  will  be  gathered  from  the  remarks  I  have  thus  made  on  the 
constitutional  effects  of  spermatorrhoea,  that  whatever  be  the  method 
of  treatment  which  may  appear  most  fit  for  adoption  under  particu- 
lar circumstances,  or  whatever  the  urgency  of  the  symptoms  that 
may  arise,  I  consider  the  primary  cause  of  the  disease  ought  to  be 
sought  after  with  diligence.  In  no  complaint  perhaps  is  it  more 
difficult  to  understand  the  complication  of  disease  which  is  likely  to 
occur  from  the  commingling  of  symptoms  as  they  are  derived  from 
their  various  sources. 

The  treatment  of  onanism  demands  more  than  common  care,  on 
account  of  the  serious  injury  it  causes  to  the  strength  and  constitu- 
tion of  the  sufferer.  It  arises  usually  at  an  age  and  under  circum- 
stances in  which  it  is  unlocked  for  and  unexpected  ;  and  previous  to 
its  discovery  has  often  obtained  a  hold  on  the  individual  that  renders 
it  more  than  usually  rebellious  to  treatment.  When  the  habit  is 
once  contracted,  there  is  every  inducement  in  the  sensations  of  the 
patient  to  pursue  it.  This  habit  originates  when  the  mind  is  not 
sufficiently  developed  to  comprehend  its  fatal  tendency.  When  the 
practice  is  discovered,  the  patient  should  be  watched  ;  he  should  not 
be  left  alone  ;  and  all  opportunity  of  solitary  seclusion  prohibited. 
Careful  attention  must  be  paid  to  diet,  and  to  the  regulation  of 
general  health.  A  proper  amount  of  muscular  exercise,  verging 
even  on  fatigue,  is  to  be  taken,  and  for  this  purpose  gymnastic  exer- 
cises are  the  most  appropriate.  The  mind  should  be  directed  to  in- 
teresting and  absorbing  occupation,  as  far  away  as  possible  from  its 
morbid  feelings.  It  is  a  prevailing  idea  that  the  disease  will  prove 
of  easy  self-correction  when  the  mind  begins  to  comprehend  the 
degradation  of  the  habit ;  and  that  as  the  child  becomes  older,  he 
will  leave  off  the  practice  of  his  own  accord.  Nothing  can  be  more 
fallacious  than  this  supposition,  and  the  reverse  is  more  generally 
the  case ;  the  demand  for  the  peculiar  excitement  becomes  more 
urgent,  and  the  moral  disgrace  lessens  in  his  own  eyes  in  proportion 
as  the  practice  acquires  an  ascendency  over  the  mind.  The  endea- 
vor to  stay  its  progress  cannot,  therefore,  be  too  prompt  or  too 
energetic.  With  very  inveterate  cases,  it  will  be  found  expedient  to 
blister  the  penis  and  neighboring  surfaces,  in  a  way  to  render  the 
continuation  of  the  practice  exceedingly  painful.  This  plan  is  often 
a  means  of  entirely  checking  the  disease,  since  it  causes  sufficient 
pain  and  smarting  to  awaken  the  patient  when  he  is  unconsciously 
pursuing  the  habit  during  sleep. 

When  spermatorrhoea  arises  from  the  habit  of  masturbation,  of 
which  it  is  commonly  the  consequence,  the  most  important  thing  to 


378  TREATMENT    OF    SPERMATORRHCEA. 

be  accomplished  is  the  removal  of  the  cause.  It  is  quite  evident 
that  little  can  be  attempted  in  the  way  of  treatment  until  that  has 
been  attained.  To  a  certain  extent  it  will  be  self-relieved  more 
especially  in  the  advanced  stages  of  atony,  occasioned  by  the  con- 
stant practice  of  the  habit.  The  system  to  be  pursued,  therefore, 
for  remedying  the  early  stages  of  spermatorrhoea  so  contracted,  is 
precisely  the  same  as  that  advised  for  counteracting  the  evil  influ- 
ences of  masturbation. 

Treating  on  this  subject,  Hufeland,  to  whom  I  have  already  had 
occasion  to  refer,  has  laid  down  a  set  of  rules  so  applicable  to  the 
plan  in  view,  that  I  feel  no  apology  necessary  for  transcribing  them. 
Speaking  of  early  life,  and  the  evil  habits  sometimes  acquired  at 
schools,  he  says  : — 

"To  this  period  belongs  also  a  very  important  point  in  regard  to 
physical  education  —  the  guarding  against  onanism;  or,  rather, 
guarding  against  too  early  a  propensity  to  amorous  enjoyment. 
As  this  evil  is  one  of  the  most  certain  and  most  terrible  of  those 
means  which  shorten  and  derange  life,  as  has  been  already  shown, 
I  consider  it  my  duty  to  speak  a  little  more  expressly  of  the  me- 
thods that  ought  to  be  employed  to  counteract  it.  I  am  fully  con- 
vinced that  this  vice  is  exceedingly  common  and  highly  destructive 
to  human  nature ;  but  that  where  it  has  once  become  habitual  it  is 
very  difficult  to  be  eradicated.  People  also  ought  not  to  imagine 
that  the  principal  helps  against  it  are  to  be  found  in  nostrums  and 
specifics,  which  generally  are  employed  too  late  ;  but  that  the  grand 
object  is  to  prevent  onanism  altogether,  and  that  the  whole  art  and 
secret  consists  consequently  in  guarding  against  too  early  an  ex- 
pansion and  excitement  of  the  propensity  to  amorous  indulgence. 
This  is  properly  the  disease  with  which  mankind  are  afflicted  at 
present,  and  of  which  onanism  is  now  the  consequence ;  for  this 
disease  may  exist  in  the  seventh  or  eighth  year,  before  onanism 
takes  place.  But  it  is  necessary  to  pursue  early  measures  for  pre- 
venting the  latter,  and  to  attend,  in  this  respect,  not  to  single  points, 
but  to  the  whole  education  in  general. 

''According  to  my  observations  and  experience,  the  following, 
when  properly  employed,  are  the  most  certain  means  to  subdue  this 
pestilence  of  youth. 

"  1.  One  must  beware,  from  the  beginning,  not  to  give  a  child 
strong,  stimulating,  nutritive  food.  Many,  indeed,  when  they  in- 
dulge their  children  very  early  with  flesh,  wine,  coffee,  and  the  like, 
do  not  reflect  that  they  are  thereby  laying  a  foundation  for  a  ten- 
dency to  this  vice.  These  stimulants,  given  so  soon,  hasten,  as  I 
have  already  shown,  expansion  of  the  organs.  It  is,  in  particular, 
hurtful  to  allow  children  at  night,  meat,  hard  eggs,  spiceries,  or 
puffing  things,  such  as  potatoes,  which,  in  this  way,  have  a  very 
powerful  effect. 

"2.  Washing  with  cold  water  daily,  as  already  mentioned ;  the 
use  of  free  air  and  light  clothing,  particularly  of  the  private  parts, 


TREATMENT    OF    SPERMATORRHCEA.  379 

are  also  of  importance.  Close  warm  breeches  often  tend  to  promote 
this  premature  expansion  ;  and  it  is  therefore  a  good  rule  to  give 
children,  during  their  first  years,  a  loose  under-frock,  and  not  to 
suffer  them  to  wear  breeches  till  a  more  advanced  period. 

"  3.  Do  not  permit  them  to  sleep  on  feather  beds,  but  on  mat- 
tresses ;  do  not  let  them  retire  to  rest  till  they  are  heartily  tired 
with  exercise,  and  cause  them  to  get  up  early  in  the  morning. 
Lolling  in  bed  in  the  morning,  between  sleeping  and  waking,  par- 
ticularly under  warm  bedclothes,  is  one  of  the  greatest  causes  of 
onanism,  and  ought  never  to  be  suffered. 

"  4.  Give  them  sufficient  exercise  daily,  so  that  their  natural 
stock  of  vigor  may,  by  muscular  motion,  be  employed  and  exhausted ; 
for,  when  a  poor  child  is  kept  sitting  the  whole  day,  and  its  body 
retained  in  a  passive  state,  is  it  to  be  wondered  at  if  its  vigor,  which 
will  and  must  have  vent,  should  assume  that  unnatural  direction  ? 
Let  a  child  or  youth  daily  exercise  his  vigor  in  the  open  air,  by 
running,  jumping,  &c.,  and  I  engage  he  will  never  fall  into  the 
detestable  vice  of  onanism.  It  is  peculiar  to  a  sedentary  educa- 
tion, in  schools  and  other  seminaries,  where  exercise  is  confined  to 
half  hours. 

"  5.  Let  not  the  powers  of  thought  and  sensation  be  strained  too 
early.  The  more  these  organs  are  refined  and  brought  to  perfec- 
tion, the  more  tendency  will  the  body  have  to  onanism. 
•  "  6.  One  should  be  particularly  cautious  in  regard  to  all  dis- 
course, writings,  or  circumstances  which  might  tend  to  excite  such 
ideas,  or  turn  the  attention  of  children  to  certain  parts.  It  will 
be  highly  necessary  to  divert  them  from  these  by  every  means  pos- 
sible ;  but  not  in  a  manner  recommended  by  some,  that  is,  making 
these  parts  interesting  to  them  by  explaining  their  nature  and  use. 
The  more  their  attention  is  drawn  to  these,  the  sooner,  without 
doubt,  can  they  be  acted  upon  by  any  stimulus ;  for  internal  atten- 
tion to  any  point  (internal  contact)  is  as  good  a  stimulus  as  external 
contact ;  and  I  agree,  therefore,  with  the  ancients,  that  the  organs 
of  generation  should  not  be  mentioned  to  a  child  before  the  age  of 
fourteen.  Of  that  for  which  nature  has  not  as  yet  organs  they 
ought  to  have  no  idea,  otherwise  the  idea  may  call  forth  the  organs 
before  the  proper  time. 

"  One,  also,  must  keep  at  a  distance  plays,  romances,  and  poems, 
which  may  have  a  tendency  to  excite  such  sensations.  Nothing 
should  be  allowed  that  may  inflame  the  imagination  of  children,  or 
lead  to  lascivious  ideas.  Great  mischief  has  been  occasioned  to 
many  by  reading  some  of  the  old  poets,  or  the  study  of  mythology; 
and  for  this  reason,  it  would  be  much  better  to  begin  a  child's 
education  with  the  study  of  nature,  botany,  zoology,  economy,  &c. 
These  subjects  can  awaken  no  unnatural  propensity,  but  preserve 
the  thoughts  pure,  and  therefore  will  act  rather  as  an  antidote  to 
anything  of  the  kind. 

"  7.  One  ought  to  watch,  with   the  utmost  care,  over  nursery- 


380  TREATMENT    OF    SPERMATORRHCEA. 

maids,  domestics,  and  others,  that  they  may  not  ignorantly  foster 
the  first  germ  of  this  dissipation,  as  is  too  often  the  case.  I  have 
met  with  some  instances,  where  children  became  onanists  merely 
throuo-h  the  nursery-maids,  who,  when  they  cried  and  would  not 
sleep,  knew  no  other  method  of  soothing  them  than  to  sport  Avith 
their  privities.  The  sleeping  together  of  two  ought  also  never  to  be 
suffered. 

"  8.  If,  however,  notwithstanding  all  these  precautions,  this  un- 
happy propensity  should  be  excited,  one  ought,  above  all  things,  to 
inquire  whether  it  may  not  be  owing  rather  to  disease  than  to 
viciousness,  to  which  hiost  of  those  intrusted  with  the  care  of  edu- 
cation pay  too  little  attention.  All  diseases,  in  particular,  which 
occasion  great  irritability  in  the  abdomen,  if  they  are  combined 
with  an  extraordinary  sensibility  of  the  nerves,  may  give  rise  to 
this  vice,  as  I  know  from  experience.  Of  this  nature  arc  worms, 
the  scrofula,  and  plethora  of  the  lower  belly,  whether  it  be  the  con- 
sequences of  too  heating  food,  or  of  too  much  sitting.  When  there 
is  any  suspicion,  therefore,  of  this  being  the  case,  one  must  always 
begin  by  removing  the  bodily  cause.  Let  the  unnatural  sensibility 
of  the  nerves  be  subdued  by  strengthening  medicines,  and  without 
any  other  helps  one  may  cure  this  propensity  to  onanism,  or  too 
great  irritability  of  the  organs  of  generation." 

Before  concluding,  I  would  remark,  that  in  cases  of  spermator- 
rhoea, from  whatever  cause  arising,  when  by  proper  treatment  th-e 
patient  has  been  restored  to  a  state  of  health,  no  inconsiderable 
amount  of  care  is  requisite  for  some  time  afterwards,  for  the  purpose 
of  preserving  him  in  a  sound  state.  When  once  the  important 
functions  of  generation  have  suffered  disarrangement,  the  liability 
to  a  return  of  the  disease  is  very  great.  However,  with  a  judicious 
plan  of  diet,  exercise,  pure  air,  and  mental  occupation,  the  disposi- 
tion to  disease  will  be  finally  subdued,  and  the  patient  may  enjoy 
the  remainder  of  life  free  from  every  symptom,  and  even  from  a 
dread  of  the  return  of  so  distressing  a  malady. 


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Hodge  on  Diseases  of  Women, "19 

Lyons  on  Fever, "21 

Meigs  on  Diseases  of  Women, "21 

Parrish's  Practical  Pharmacy, "25 

Slade  on  Diphtheria,           ...........  "26 

Stille's  Tlierapeutics  and  Materia  Medica, "27 

Simpson  on  Diseases  of  Women, "27 

Toyiibee  on  the  Ear, "29 

Watson's  Practice  of  Physic, "30 

Walshe  on  the  Lungs, "JO 

Win?  low  on  Brain  and  Mind, "32 

West  on  Diseases  of  Children, "32 

West  on  Diseases  of  Women, "32 

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CLINICAL   LECTURES  ON   THE    DISEASES  OF   WOMEN. 

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WITH    NUMEROUS    HANDSOME    ILLUSTRATIONS. 

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Address  BLANCHARD  &  LEA,  PniLADKLrHiA. 


AND    SCIENTIFIC    PUBLICATIONS. 


ASHTON   (T.  J.), 
Surgeon  to  the  Blenheim  Dispentary,  &c. 

ON   THE   DISEASES,  INJURIES,  AND   MALFORMATIONS   OF    THE 

RECTUM  AND  ANUS;  wilh  remarks  on  Habitual  Constipation.  From  the  third  andenlaro-ed 
London  ediiion  With  handsome  illustrations.  In  one  very  beautifully  printed  octavo  volume 
oi  about  300  pages.     {Just  Issued.)     $2  00.  ' 

Introduction.  Chapter  I.  irritation  and  Itching  of  the  Anus.  II.  Inflammation  and  E.Kcona- 
tion  ot  the  Anus.  III.  Excrescences  of  the  Anal  Region.  IV.  Contraction  of  the  Anus.  V 
Fissure  of  the  Anus  and  lower  part  of  the  Rectum.  V[.  Neuralgia  of  the  Anus  and  extremitv 
of  the  Rectum.  VII.  Inflammation  of  the  R-clum.  VHI.  Ulceration  of  the  Rectum.  IX  He- 
morrhoidal Aflections.  X.  Enlargement  of  Hemorrhoidal  Veins.  XI.  Prolapsus  of  the  Rectum 
All.  Abscess  near  the  Rectum.  XLII.  Fistula  in  Ano.  XIV.  Polypi  of  the  Rectum.  XV  Stric- 
ture of  the  Pwectum.  XVI.  Malignant  Di.-ea-es  of  the  Rectum.  XVII.  Injuries  of  the  Rectum 
XVHI.  Foreign  Bodies  in  the  ileetum.  XIX.  Malformations  of  the  Rectum.  XX.  Habitual 
Constipation. 


The  most  complete  one  we  possess  on  the  subject. 
Medico- Chirurgical  Re.view. 

We  are  satisfied,  after  a  careful  examination  of 
the  volume,  and  a  comparison  of  its  cimtonts  witn 
those  of  its  leading  predecessors  and  contemporaries, 
that  the  best  way  for  the  reader  to  avail  himself  of 


the  excellent  advice  given  in  the  concluding  para- 
graph above,  would  be  to  provide  himself  with  a 
c  >py  of  the  b.juk  from  which  it  has  been  taken,  and 
diligently  to  con  its  instructive  pages.     Tliey  mjy 

secure  to  him  m  iny  a  triumpti  and  fervent  blessin". 

Am.  Journal  Med.  Sciences,  April,  1653. 


ALLEN    (J.    M.),    M.  D., 

Professor  of  Anatomy  in  the  Pennsylvania  Medical  College,  to. 

THE  PRACTICAL  ANATOMIST;  or,  The  Student's  Guide  iu  the  Dissecting. 

ROOM.     With  266  illustratioas.    In  one  handsome  royal  12mo.  volume,  of  over  600  pages  lea- 
ther.    $2  25.  ^         ' 

We  believe  it  to  be  one  of  the  most  useful  works  I  notice,  we  feel  confident  that  the  work  of  Dr.  Allen 
apon  the  subject  ever  written.     It  is  handsomely  |  is  superior  to  any  of  tliem.     We  believe  with  the 


illustrated,  well  printed,  and  will  be  found  of  con 
venient  size  for  use  in  the  dissecting-room. — Med. 
Examiner. 

However    valuable    may    be    the    "  Dissector's 
Guides"  which  we,  of  late,  have  had  occasion  to 


luthor,  that  none  is  so  fully  illustrated  as  this,  and 
the  arrangement  of  the  work  is  such  as  to  facilitate 
the  labors  of  the  student.  We  most  cordiilly  re- 
commend It  to  their  attention. —  Western  Lan:et. 


ANATOMICAL   ATLAS. 
By  Professors  H.  H.  Smith  and  W.  E.  Horner.,  of  the  University  of  Pennsyl- 
vania.    1  vol.  Svo.,  extra  cloth,  with  nearly  650  illusirauons.     O^  See  S.mith,  p.  331. 

ABEL  (F.   A.),    F.  C.S.    AND    C.    L.    BLOXAM. 
HANDBOOK  OP  CHEMISTRY,  Theoretical,  Practical,  and  Technical;  with  a 

Recommendatory  Preface  by  Dr.  Hofmann.  In  one  large  octavo  volume,  extra  cloth,  of  662 
pages,  with  illustrations.    $3  25. 

ASHWELL   (SAMUEL),   M .  D., 

Obstetric  Physician  and  Lecturer  to  Guy's  Hospital,  London. 

A  PRACTICAL  TREATISE  ON  THE  DISEASES  PECULIAR  TO  W03IEN. 

Illustrated  by  Cases  derived  from  Hospital  and  Private  Practice.  Third  American,  from  the  Third 
and  revised  London  ediiion.     In  one  octavo  volume,  extra  cloth,  of  528  pages.     $3  00. 
The  most  useful  practical  work  on  the  subject  in  I      The  most  able,  and  certainly  the  most  standard 
the  English  language.  —  Boston  Med.  and  ^'argr.    and  practical,  work  on  female  diseases  that  we  have 
Journal.  \  yet  seen. — Medico-Chirurgical  Review. 

ARNOTT   (NEILL),  M.  D. 
ELEMENTS    OF    PHYSICS;    or  Natural  Philosophy,  General  and  Medical. 

Written  lor  universal  use,  in  plain  or  non-technical  language.  A  new  edition,  by  Isaac  Hays, 
M.  D.  Complete  in  one  octavo  volume,  leather,  of  484  pages,  with  about  two  hundred  illusira- 
tions.     $2  50. 

BIRD  (GOLDING),  A.  M.,  M.  D.,  Stc. 
URINARY     DEPOSITS:     THEIR     DIAGNOSIS,    PATHOLOGY,    AND 

THERAPEUTICAL  INDICATIONS.  Edited  by  Edmund  Lloyd  Birkett,  M.  D.  A  new 
American,  from  the  fifth  and  enlarged  London  edition.  With  eighty  illustrations  on  wood.  In  one 
handsome  octavo  volume,  of  aoout  400  pages,  extra  cloth.     $2  00.     {Just  Issued.) 

The  death  of  Dr.  Bird  has  rendered  it  necessary  to  entrust  the  revision  of  the  present  edition  to 
other  hands,  and  in  his  performance  of  the  duty  thus  devolving  on  him,  Dr.  Birkett  has  sedulously 
endeavored  to  carry  out  the  author's  plan  by  introducing  such  new  matter  and  modilications  o( 
the  text  as  the  progress  of  science  has  called  for.  Notwithstanding  the  utmost  care  to  keep  the 
work  within  a  rea'sonable  compass,  these  additions  have  resulted  in  a  considerable  enlargement. 
It  is,  therefore,  hoped  that  it  will  be  found  fully  up  to  the  present  condition  of  the  subject,  and  that 
the  reputation  of  the  volume  as  a  clear,  complete,  and  compendious  manual,  will  be  fully  maintained. 

BENNETT   (J.    HUGHES),    M.D.,    F.  R.  S.  E., 

Professor  of  Clinical  Medicine  in  the  University  of  Edinburgh,  &.c. 

THE  PATHOLOGY  AND  TREATMENT  OF  PULMONARY  TUBERCU- 
LOSIS, and  on  the  Local  Medication  of  Pharyngeal  and  Laryngeal  Disea.ses  frequently  mistaken 
for  or  associated  with.  Phthisis.     Oue  vol.  8vo.,extra  cloth,  with  wood-cuts.    pp.  130.     $1  25. 


BLANCHARD   &    LEA'S   MEDICAL 


BUDD  (GEORGE),  M .  D.,  F.  R.  S., 

Professor  of  Medicine  in  King's  College,  London. 

ON   DISEASES   OF  THE   LIVER.      Third  American,  from   the   third   and 

enlarged  London  edition.    In  one  very  handsome  octavo  volume,  extra  cloth,  with  four  beauti- 
fully colored  plates,  and  numerous  wood-cuts.     pp.  500.     $3  00. 

Has  fairly  established  for  itself  a  place  among  the  i  is  not  perceptibly  changed,  the  history  of  liver  dis- 
classical  medical  literature  of  England. — £rj«wA  !  eases  is  made  more  complete,  and  is  kept  upon  a  level 
and  Foreign  Medico-Chir.  Review,  July,  18-57.  [  witli  the  progress  of  modern  science.     It  is  the  best 

Dr.  Budd's  Treatise  on  Diseases  of  the  Liver  is  I  ^ork  on  Diseases  of  the  Liver  in  any  language.- 
now  a  standard  work  in  Medical  literature,  and  dur-  j  London  Med.  Times  and  Gazette,  June  27,  1^57. 
ing  the  intervals  which  have  elapsed  between  the  I  This  work,  now  the  standard  book  of  reference  on 
successive  editions,  the  author  has  incorporated  into  !  the  diseases  of  which  it  trnats,  has  been  carefully 
the  text  the  most  striking  novelties  which  have  cha-  !  revised,  and  many  new  illustrations  of  the  views  of 
racterized  the  recent  progress  of  hepatic  physiology  I  the  learned  author  added  in  the  present  edition. — 
and  pathology;  so  thatalthough  the  size  of  the  book  I  Dublin  Quarterly  Journal,  Aug.  1&57. 

BY  THE  SAME  AUTHOR. 

ON  THE   ORGANIC  DISEASES   AND  FUNCTIONAL  DISORDERS  OF 

THE  STOMACH.    In  one  neat  octavo  volume,  extra  cloth.    $1  50. 


BUCKNILL  fJ.  C),   M.  D.,  and        DANIEL   H.   TUKE,    M.  D., 

Medical  Superintendent  of  the  Devon  Lunatic  Asylum.        Visiting  Medical  Officer  to  the  York  Retreat. 

A  MANUAL  OF   PSYCHOLOGICAL   MEDICINE;   containing  the  History, 

Nosology,  Defoription,  Statistics,  Diaffnosis,  Pathology,  and  Treatment  of  INSANITY.     With 

a  Plate.     In  oce  handsome  octavo  volume,  of  536  pages.     $3  00. 

The  increase  of  merflal  disease  in  its  various  forms,  and  the  dilTicuU  questions  to  which  it  is 
constantly  giving  rise,  render  the  subject  one  of  daily  enhanced  interest,  requiring  on  the  part  of 
the  physician  a  constantly  greater  familiarity  with  this,  the  most  perplexing  branch  of  his  profes- 
sion. At  the  same  time  there  has  been  for  some  years  no  worlc  accessible  in  this  country,  present- 
ing the  results  of  recent  investigations  in  the  Diagnosis  and  Prognosis  of  Ins-anity,  and  the  greatly 
improved  methods  of  ireatment  which  have  done  so  much  in  alfeviating  the  condition  or  restoring 
the  health  of  the  insane.  To  fill  this  vacancy  the  publishers  present  this  volume,  assured  that 
the  distinguished  reputation  and  experience  of  the  authors  will  entitle  it  at  once  to  the  confidence 
of  both  student  and  practitioner.  Its  scope  may  be  gathered  from  the  declaration  of  the  authors 
that  "their  aim  has  been  to  supply  a  text  book  which  may  serve  as  a  guide  in  the  acquisition  of 
such  knowledge,  sufficiently  elementary  to  be  adapted  to  tlie  wants  of  the  student,  and  sufficiently 
modern  in  its  views  and  explicit  in  its  teaching  to  suffice  for  the  demands  of  the  practitioner." 


BENNETT   (HENRY),  M.  D. 
A  PRACTICAL   TREATISE    ON  INFLAMMATION  OF  THE  UTERUS, 

ITS  CERVIX  AND  APPENDAGES,  and  on  its  connection  with  Uterine  Disease.  To  which 
is  added,  a  Review  of  the  present  stale  of  Uterine  Pathology.  Fifth  American,  from  the  third 
English  edition.  In  one  octavo  volume,  of  about  500  pages,  extra  clolh.  $2  00.  (Now  Ready.) 
The  ill  health  of  the  author  having  prevented  the  promi-^cd  revision  of  this  work,  the  present 

edition  is  a  reprint  of  the  last,  without  alteration.     As  ilie  volume  has  been  for  some  time  out  of 

print,  gentlemen  desiring  copies  can  now  procure  them. 

BROWN    (ISAAC    BAKER), 

Surgeon- Accoucheur  to  St.  Mary's  Hospital,  &c. 

ON  SOME  DISEASES  OF  WOMEN  ADMITTING  OF  SURGICAL  TREAT- 
MENT.   With  handsome  illustrations.    One  vol.  8vo.,  extra  cloth,  pp.  276.    $160. 
Mr.  Brown  has  earned  for  himself  a  high  reputa-    and  merit  the  careful  attention  of  every  surgcoa- 

tion  in  the  operative  treatment  of  sundry  diseases    accoucheur. — Association  Journal. 

and  injuries  to  which  females  are  peculiarly  subject.        ,,.    ,  x      ■..  .■       ■  j-       ^u-    l     i. 

We  can  truly  say  of  his  work  that  it  is  an  important  1      ^Y^  have  no  hesitation  in  recommending  this  bork 

addition  to  obstetrical  literature.     The  operative    to  t.ie  careful  attention   of  all   surgeons  who  make 

suggestions  and  contrivances  which  Mr.  Brown  dt-    feniaie  comp.ainls  a  part  of  their  study  aud  practice. 

schbes,  exhibit  much  practical  sagacity  and  sWn\,\— Dublin  Quarterly  Journal. 


BOWMAN  (JOHN   E.),  M.D. 
PRACTICAL  HANDBOOK   OF   MEDICAL    CHExMISTRY. 


Second  Ame- 


rican, from  the  third  and  revised  English  Edition.     In  one  neat  volume,  royal  12mo.,  extra  cloth, 
with  numerous  illustrations,    pp.  2S8.     $125. 

BY  THE  SAME  AUTHOE. 

INTRODUCTION   TO    PRACTICAL    CHEMISTRY,    INCLUDING    ANA- 

LYSIS.    Second  American,  from  the  second  and  revised  London  edition.     With  numerous  illus- 
trations.   In  one  neat  vol.,  royal  r2mo.,  extra  cloth,    pp.350.    $125. 


BEALE  ON  THE  LAWS  OF  HEALTH  IN  RE- 
LATION TO  MIND  AND  BODY.  A  Series  of 
Letters  from  an  old  Practitioner  to  a  Patiept.  In 
one  volume,  royal  12mo.,  extra  cloth,  pp.  296. 
80  cents. 

BUSHNAN'S  PHYSIOLOGY  OF  ANIMAL  AND 
VEGETABLE  LIFE;  a  Popular  Treatise  on  the 
Functions  and  Phenomena  of  Organic  Life.  In 
one  handsome  royal  J2mo.  volume,  extra  cloth, 
with  over  100  illustrations,    pp.  234.    80  cents. 


BUCKLER  ON  THE  ETIOLOGY,  PATHOLOGY, 
AND    TREATMENT   OF    FIBRO-BRONCHl- 

,  TIS  AND  RHEUMATIC  PNEU.MONIA.  In 
one  8vo.  volume,  extra  cloth,     pp.150.     $125. 

BLOOD  AND  URINE  (MANUALS  ON).  BY 
JOHN  WILLIAM  GRIFFITH,  G.  OWEN 
REESE,  AND  ALFRED  MARKWICK.  One 
thick  volume,  royal  12ino.,  extra  cloth,  with 
plates,    pp.  460.     $1  25. 

BRODIE'S  CLINICAL  LECTURES  ON  SUR- 
GERY.   1  vol.  8vo.  cloth.    350  pp.    8125. 


AND    SCIENTIFIC    PUBLICATIONS. 


BUMSTEAD  (FREEMAN  J.)  M.  D,, 
Lecturer  on  Venereal  Diseases  at  the  College  of  Piiysicians  and  Surgeons,  New  York,  &c. 

THE   PATHOLOGY   AND   TREATMENT   OF   VENEREAL  DISEASES, 

including  the  results  of  recent  investigations  upon  the  subject.  With  illustrations  on  wood.  Iq 
one  very  handsome  octavo  volume,  of  nearly  700  pages.  (Nearly  Ready.) 
The  object  of  the  author  has  been  to  prepare  a  complete  work,  which  should  present  the  results 
of  the  most  recent  researches  and  modern  experience  on  all  branches  of  the  subject,  with  special 
reference  to  the  wants  of  the  practitioner,  theoretical  disquisitions  being  rendered  subordinate  to 
practical  utility.  To  show  the  thoroughness  of  the  outlme  which  is  thus  filled  up,  a  condensed 
synopsis  of  the  contents  is  subjoined. 

CONTENTS. 

Introduction. 

PART  1.— GoNORRHCEA  AND  ITS  COMPLICATIONS.— CHAPTER  I.  Urethral  Gonorrhoea  in  the  Male. 
II.  Gleet  III.  Balanitis.  JV.  Phymosis.  V.  Paraphymosis.  VI.  Swelled  Testicle.  VII. 
Inflammation  of  the  Prostate.  VIII.  Inflammation  of  ttie  Bladder.  IX.  Gonorrhoea  in  Women. 
X.  Gonorrhipal  Ophthalmia.  XI.  Gonorrhceal  Rheumatism.  XII.  Vegetations.  XIII.  Stric- 
ture of  the  Urethra. 

PART  II. — The  Chancroid  and  its  Complications:  Syphilis.— Chap.  I.  Introductory  remark"?. 
II.  Ciiancres.  III.  Affections  of  the  Lymphatic  Vessels  and  Ganglia  attendant  upon  Primary 
Sores.  IV.  General  Syphilis — Introductory  remarks.  V.  Treatment  of  Syphilis.  VI.  Syphi- 
litic Fever — State  of  the  Blood— Afleclions  of  Lymphatic  Ganglia.  VII.  Syphilitic  Aflectio'ns  of 
the  Skin.  VIII.  Syphilitic  Alopecia,  Onychia,  and  Paronychia.  IX.  Mucous  Patches.  X. 
Gummy  Tumors.  XI.  Syphilitic  Affections  of  Alucous  Membranes.  XII.  Syphilitic  Aft",;ctions 
of  the  Eye.  XIII.  Syphilitic  Aflections  of  the  Ear.  XIV.  Syphilitic  Orchitis.  XV.  Syphilitic 
Afl^ections  of  the  Muscles  and  Tendons.  XVI.  Syphilitic  Aflections  of  the  Nervous  System. 
XVII.  Syphilitic  Aflections  of  the  Periosteum  and  Bones.     XVIII.  Congenital  Syphilis. 


BARCLAY  (A.  W.),  M.  D., 

Assistant  Physician  to  St.  George's  Hospital,  &c. 

A  MANUAL  OF  MEDICAL  DIAGNOSIS ;   being  an  Analysis  of  the  Signs 

and  Symptoms  of  Disease.    In  one  neat  octavo  volume,  extra  cloth,  of  424  pages.    $2  00.    (LcUdy 
issued.) 


The  task  of  composing  such  a  work  is  neither  an 
easy  nor  a  light  one  ;  but  Dr.  Barclay  has  performed 
it  in  a  manner  which  meets  our  most  unqualified 
approbation.  He  is  no  mere  theorist;  he  knows  his 
work  thoroughly,  and  in  attempting  to  perform  it, 
has  not  exceeded  his  powers. — British,  Med.  Journal, 
Dec.  5,  1857. 

We  venture  to  predict  that  the  work  will  be  de- 
servedly popular,  and  soon  become,  like  Watson's 
Practice,  an  indispensable  necessity  to  the  practi- 
tioner.— JV.  A.  Med.  Journal,  April,  1858. 

An  inestimable  work  of  reference  for  the  young 
practitioner  and  student. — Nashville  M»d.  Journal, 
May,  1858. 


We  hope  the  volume  will  have  an  extensive  cir- 
culation, not  among  students  of  medicine  only,  but 
practitioners  also.  They  will  never  regret  a  faith- 
ful study  of  its  pages. —  Cincinnati  Lancet,  Mar.  '58. 

An  important  acquisition  to  medical  literiture. 
It  IS  a  work  of  high  merit,  both  from  the  vast  im- 
por:ance  of  the  subject  upon  which  it  treats,  and 
also  from  the  real  aDility  displayed  in  its  elabora- 
tion. In  conclusion,  let  us  bespeak  for  this  volume 
that  attention  of  every  student  of  our  art  which  it 
so  richly  deserves  —  that  place  in  every  medical 
library  which  it  can  so  well  adoru. — Peninsular 
Medical  Journal,  Sept.  1858. 


BARLOW   (GEORGE  H.),   M.  D. 

Physician  to  Guy's  Hospital,  London,  &c. 

A  MANUAL  OF  THE  PRACTICE  OF  MEDICINE.     With  Additions  by  D. 

F.  CoNDiE,  M.D.,  author  of  "A  Practical  Treatise  on  Diseases  of  Children,"  &c.    lu  one  hand- 
some octavo  volume,  leather,  of  over  600  pages.     $2  75. 

will  be  found  hardly  less  useful  to  the  experienced 
physician.  The  American  editor  has  added  to  the 
work  three  chapters — on  Cholera  Infantum,  Yellow 
Fever,  and  Cerebro-spinal  iMeningitis.  Tliese  addi- 
tions, the  two  first  of  which  are  indispensable  to  a 
work  on  practice  destined  for  the  profession  in  this 
country,  are  executed  with  great  judgment  and  fi- 
delity, by  Dr.  Condie,  who  has  also  succeeded  hap- 
pily in  imitating  the  conciseness  and  clearness  of 
style  which  are  such  agreeable  characteristics  of 
the  original  book. — Boston  Med.  and  Surg.  Journal. 


WerecommendDr.  Barlow'sManualin  the  warm- 
est manner  as  a  most  valuable  vade-mecum.  We 
have  had  frequent  occasion  to  consult  it,  and  have 
found  it  clear,  concise,  practical,  and  sound.  It  is 
eminently  a  practical  work,  containing  all  that  is 
essential,  and  avoiding  useless  theoretical  discus- 
sion. The  work  supplies  what  has  been  for  some 
time  wantingj  a  manual  of  practice  based  upon  mo- 
dern discoveries  in  pathology  and  rational  views  of 
treatment  of  disease.  It  is  especially  intended  for 
the  use  of  students  and  junior  practitioners,  but  it 


BARTLETT  (ELISHA),  M.  D. 
THE   HISTORY,  DIAGNOSIS,  AND  TREATMENT  OF  THE  FEVERS 

OF  THE  UNITED  STATES.  A  new  and  revised  edition.  By  Alonzo  Clark,  M.  D.,  Prof, 
of  Pathology  and  Practical  Medicine  in  the  N.  Y.  College  of  Physicians  and  Surgeons,  &c.  In 
one  octavo  volume,  of  six  hundred  pages,  extra  cloth.    Price  $3  00. 

stood  deservedly  high  since  its  first  publication.     It 


It  is  a  work  of  great  practical  value  and  interest, 
containing  much  that  is  new  relative  to  the  several 
diseases  of  which  it  treats,  and,  with  the  additions 
of  the  editor,  is  fully  up  to  the  times.  The  distinct- 
ive features  of  the  different  forms  of  fever  are  plainly 
and  forcibly  portrayed,  and  the  lines  of  demarcation 
carefully  and  accurately  drawn,  and  to  the  Ameri- 
can practitioner  is  a  more  valuable  and  safe  guide 
than  any  work  on  fever  extant. — Ohio  Med.  and 
Surg  Journal. 

This  excellent  monograph  on  febrile  disease,  has 


will  be  seen  that  it  has  now  reached  its  fourth  edi- 
tion under  the  supervision  of  Prof.  A.  Clark,  a  gen- 
tleman who,  from  the  natur*  of  his  studies  and  "pur- 
suits, is  well  calculated  to  appreciate  and  discuss 
the  many  intricate  and  diflicult  questions  in  patho- 
logy. His  annotations  add  much  to  the  interest  of 
the  work,  and  have  brought  it  well  up  to  the  condi- 
tion of  the  science  as  it  exists  at  the  present  uay 
in  regard  to  this  class  of  diseases. — Southern  Med. 
and  Surg.  Journal. 


BLANCHARD  &  LEA'S    MEDICAL 


BARWELL  (RICHARD,)    F*  R.  C.  S., 

Assis'ant  Surgeon  Charing  Cross  Hospital,  &c. 

A  TREATISE  ON  DISEASES  OF  THE  JOINTS.  Illustraterl  with  engrav- 
ing's on  wood.  In  one  very  handsome  oclavo  volume,  of  about  500  pages.  {Nearly  Ready.) 
"A  treatise  on  Diseases  of  the  Joints  equal  to,  or  raiiier  beyond  the  current  knowledge  of"  Ihe 
dav,  lias  long  bt-en  required — my  professional  brelhren  must  judge  whether  the  ensuing  pages  may 
supply  ihe  deficiency  No  auihor  is  fit  lo  estimate  his  own  work  at  the  moment  ot  its  completion, 
but  it  maybe  permitted  me  to  say  thai  the  study  of  joint  diseases  has  very  much  occupied  my  atten- 
tion, eveii  from  my  studentship,  and  that  for  the  la~t  six  or  eight  years  my  devotion  to  that  subject 

has  been  almost  uiiremitiing The  real  weight  of  my  work  has  been  at  the  bedside, 

and  the  greatest  labor  devoted  to  interpreting  symptoms  and  remedying  their  cause." — Author's 
Preface. 


At  the  outset  we  may  state  Miat  Ihe  work  is 
worthy  of  much  praise,  and  hears  evidence  ol  much 
thoughtful  uiid  ciirefiil  inquiry,  and  here  and  there 
of  no  slight  originality  We  have  already  carriid 
U\U  notice  further  th»n  we  iniended  to  do,  hut  not 
tollieexlenl  llie  work  detervcs.  We  cin  only  add, 
that  the  perusal  of  it  hag  afforded  us  great  pleasure. 
The  author  has  evidently  worked  very  hard  at  his 
subject,  and  his  inveRiigfilionis  into  the  Physiology 
and  P^tholi'gy  of  J  'inls  have  heen  carried  on  in  a 
manner  which  entitles  hinri  to  be  listened  lo  wi'h 
attention  at.d  respect.  We  must  not  omit  to  men- 
tion tlie  very  admirable  plates  with  which  Ihe  vo- 
lume is  enriched.  We  seldom  meet  with  sucli  sink- 
ing  and  faithful  deline  iti"ns  of  di8(ase. — London 
Meil.  Times  and  Gazette,  Feb.  9,  IbGl. 

We  cannot  take  leave,  however,  of  Mr.  Barwell, 
without  cons ratulating  him  on  Ihe  Interesting 
amount  of  information  which  he  has  compressed 
into  liis  book.     Tlie  work  appears  lo  us  calculated 


to  be  of  much  use  to  the  practising  surgeon  who 
may  be  in  want  ot  a  treatise  on  diseases  of  the  jo;nts, 
and  a'  the  same  time  one  which  contains  the  latest 
information  on  artiiular  affections  and  the  opera- 
tions for  their  cure.— Dvblin  Med.  Press,  Feb.  27, 
IvSOl. 

This  volume  will  be  welcomed,  both  by  the  pa- 
thologist and  the  surgeon,  as  being  the  record  of 
mucn  honest  reseireh  and  careful  investigation  into 
the  nature  and  treatment  of  a  most  important  class 
of  disorc'ers.  We  cannot  conclude  this  notice  of  a 
valuable  and  u?»ful  book  without  calling  attention 
to  the  amount  of  broiUfi'le  work  it  contains.  In  the 
present  day  of  universal  book- making,  it  is  no  slight 
matter  for  a  volume  to  show  laboriiius  investiga- 
tion, and  at  the  same  ti  ne  original  thought,  on  th« 
part  of  its  au  hor.  whom  ve  may  congratulate  on 
tlie  successlul  crapletion  of  his  arduous  task. — 
London  Lancet,  March  9,  ltd. 


CARPENTER  (WILLIAM    B.),  M.  D.,  F.  R.  S.,  &c., 
Examiner  in  Physiology  and  Comparative  Anatomy  in  the  University  of  Loudon. 

PRINCIPLES  OF  HUMAN  PHYSIOLOGY;  with  their  chief  applications  to 

Psychology,  Pathology,  Therapeutics,  Hygiene,  and  Forensic  Medicine.  A  new  American,  from 
the  last  and  revised  London  edition.  With  nearly  three  hundred  illustrations.  Edited,  with  addi- 
tions, by  Francis  GrRNEY  Smith,  M.  D.,  Professor  of  the  Institutes  of  Medicine  in  the  Pennsyl- 
vania Medical  College,  iSrc.  In  one  very  large  and  beautiful  octavo  volume,  ot  about  nine  hundred 
large  pages,  handsomely  printed  and  strongly  bound  in  leather,  with  raised  bands.     $4  25.    ' 

In  the  preparation  of  this  new  edition,  the  auihor  ha«  spared  no  labor  to  render  it,  as  heretofore, 
a  complete  and  lucid  exposition  of  the  most  advanced  condition  of  its  important  subject.  The 
amount  of  the  additions  required  to  effect  this  object  thoroughly,  joined  to  the  former  large  size  of 
the  volume,  presenting  objections  ari^ing  from  the  unwieldy  bulk  of  the  work,  he  has  omitted  all 
those  portions  not  bearing  directly  upon  Human  PiiYsioLOGy,  designing  to  incorporate  them  in 
his  forthcoming  Treatise  on  General  Physiology.  As  a  full  and  accurate  text-book  on  the  Phy- 
siology of  Man,  the  work  in  its  present  condition  therefore  presents  even  greater  claims  upon 
the  student  and  physician  than  those  which  have  heretofore  won  for  it  the  very  wide  and  distin- 
guished favor  which  it  has  so  long  enjoyed.  The  additions  of  Prof.  Smith  will  be  found  to  supply 
whatever  may  have  been  wanting  to  the  American  student,  while  the  introduction  of  many  new 
illustrations,  and  the  most  careful  mechanical  execution,  render  the  volume  cue  of  the  most  at- 
tractive as  yet  issued. 

For  upwards  of  tliirteen  years  Dr.  Carpenter'si  To  eulogize  thisgreat'work  would  be  superfluous, 
work  has  been  considered  by  the  profession  gene-  We  should  observe,  however,  that  in  this  edition 
rally,  both  in  this  country  and  England,  as  the  most  the  author  has  remodelled  a  large  portion  of  the 
valuable  compendium  on  the  Eul)ject  of  physiology  former,  and  the  editor  has  added  much  matter  of  in- 
in  our  language.  This  distinction  it  owes  to  the  high  terest,  especially  in  the  form  of  illustrations.  We 
altainiiienls  and  unwearied  industry  of  its  accom-  may  confidently  recommend  it  as  the  most  complete 
plished  author.  Thepresentedition  (which. like  the  ]  work  on  Human  Physiology  in  our  language. — 
last  American  one,  was  prepared  by  the  autlior  him-    Houtkern  Mtd.  mid  Surg.  Journal. 


self),  is  the  result  of  such  extensive  revision,  tliat  it 
may  alumst  be  cimsidered  a  new  work.  We  need 
hardly  say,  in  cimcluding  this  brief  notice,  that  while 
the  work  is  indispi  nsalile  to  every  student  of  medi- 
cine in  this  country,  it  will  amply  repay  the  practi- 
titmer  for  its  perusal  by  the  interest  and  value  of  its 
contents. — Boston  Med.  and  Surg.  Journal. 

This  is  a  standard  work — the  text-book  used  by  all 
medical  students  who  read  the  English  language. 
It  has  passed  thr<mgh  several  editions  in  order  to 
keep  pace  w^ith  the  rapidly  growing  science  of  Phy- 


The  most  complete  work  on  the  science  in  our 
language. — Am.  Med.  Journal. 

The  most  complete  work  now  extant  in  our  lan- 
guage.— N.  O.  Med.  Register. 

The  best  text-book  in  the  language  on  this  ex- 
tensive subject. — London  Med.  Times. 

A  complete  cyclopaedia  of  this  branch  of  Bcienco. 
—N.  Y.  Med.  Times. 

The  profession  of  this  country,  and  perhaps  also 

of  Europe,  have  anxiously  and  for  some  time  awaited 

Biology.     Nothing  need  be  said  in  its  praise,  for  its  i  the  announcement  of  this  new  edition  of  Carpenter's 


merits  are  universally  known  ;  we  have  ncithing  to 
say  of  its  defects,  for  they  only  appear  where  the 
science  of  which  it  treats  is  incomplete. — Western 
Lancet. 

The  most  complete  exposition  of  physiology  which 
any  language  can  at  present  give. — Brit,  and  For. 
tled.-Chirurg.  Beviete. 

The  greatest,  the  most  reliable,  and  the  best  book 
on  the  subject  which  we  know  of  in  the  English 
tangaage. — Stethoscopt. 


Human  Physiology.  His  former  editions  have  for 
many  years  been  almost  the  only  text-book  on  Phy- 
siology in  all  our  medical  schools,  and  its  circula- 
tion among  the  profession  has  been  unsurpassed  by 
any  work  in  any  department  of  medical  science. 

It  is  quite  unnecessary  for  us  to  speak  of  this 
work  as  its  merits  W(mld  justify.  The  mere  an- 
nouncement of  itsappearance  will  afford  the  highest 
pleasure  to  every  student  of  Physiology,  while  its 
perusal  will  be  of  infinite  service  in  advancing 
physiological  science. — Ohio  Med.  and  Surg.  Journ. 


AND    SCIENTIFIC    PUBLICATIONS. 


CARPENTER  (WILLIAM  B.),   M.  D.,  F.  R.  S., 
Examiner  in  Physiology  and  Comparative  Anatomy  in  the  University  of  London. 

THE  MICROSCOPE  AND  ITS  REVELATIONS.      With  an  Appendix  con 

taming  the  Applieations  of  the  Microscope  to  Clinical  Medicine,  &c.  By  F.  G.  tiinxH  M  D 
Illustrated  by  four  hundred  and  thirty-four  beautiful  engravings  on  wood.  In  one  large  and  ven 
handsome  octavo  volume,  of  724  pages,  extra  cloth,  $4  00  ;  leather,  i4  50.  ' 


Dr.  Carpenter  s  position  as  a  microscopist  and  physiologist,  and  his  great  experience  as  a  teacher 
eminently  qualify  him  to  produce  v^^hat  has  long  been  wanted— a  good  text-book  on  the  practical 
use  of  the  microscope.  In  the  present  volume  his  object  has  been,  as  stated  in  his  Preface  "  to 
combine,  within  a  moderate  compass,  that  information  with  regard  to  the  use  of  his  <  tooN  '  which 
IS  most  essential  to  the  working  microscopist,  with  such  an  account  of  the  objects  be«t  fitted  for 
his  study,  as  might  qualify  him  to  comprehend  what  he  observes,  and  might  thus  prepare  him  to 
benefil  science,  whilst  expanding  and  refreshing  his  own  mind  "  That  he  has  succeeded  in  accom- 
plishing this,  no  one  acquainted  with  his  previous  labors  can  doubt. 

The  great  importance  of  the  microscope  as  a  means  of  diagnosis,  and  the  number  of  microseo- 
pists  who  are  also  physicians,  have  induced  the  American  publishers,  with  the  author's  approval  to 
addan  Appendix,  carefully  prepared  by  Professor  Smith,  on  the  applications  of  the  instrument' to 
clinical  medicine,  together  with  an  account  of  American  Microscopes,  their  modification*  and 
accessories.  This  portion  of  the  work  is  illustrated  with  nearly  one  hundred  wood-cuts  and^  it  is 
hoped,  will  adapt  the  volume  more  particularly  to  the  use  of  the  American  student.  '        ' 

Those  who  are  acquainted  with  Dr.  Carpenter's  [  medical  work,  the  additions  by  Prof  Smith  eive  it 
previous  v^ritings  on  Animal  and  Vegetable  Physio-  i  a  positive  claim  upon  the  profession,  for  which  we 
logy,  will  lully  understand  how  vast  a  store  of  know-  doubt  not  he  will  receive  their  sinrere  thanks  In 
ledge  he  is  able  to  bring  to  bear  upon  so  comprehen-  I  deed,  we  know  not  where  the  student  of  medicine 
give  a  subject  as  the  revelations  of  the  microscope  j  will  find  such  a  complete  and  satisfactory  collection 
and  even  those  who  have  no  previous  acquaintance  j  of  microscopic  facts  bearing  upon  physiolosry  and 
with  the  construction  or  uses  of  this  instrument,  ,  practical  medicine  as  is  contained  in  Prof  Ssmith's 
will  find  abundance  of  information  conveyed  in  clear  i  appendix;  and  this  of  itself,  it  seems  to  us  is  fully 
and   simple  language.— illed.    Ti^nes  and   Gazette.]  wortii  the  coat  oC  the  volume.— Louisville'Medical 

Although  originally  not  intended  as  a  strictly  1  R^^'^^i^w. 

BY  THB   SAME   AUTHOR. 

ELEMENTS  (OR  MANUAL)  OP  PHYSIOLOGY,  INCLUDING  PHYSIO- 

LOGICAL  ANATOMY.  Second  American,  from  a  new  and  revised  London  e<lition.  With 
one  hundred  and  ninety  illustrations.  In  one  very  handsome  octavo  volume,  leather,  dd  566 
$3  00.  ^^' 

In  publishing  the  first  edition  of  this  work,  its  title  was  altered  from  that  of  the  London  volume, 
by  the  substitution  of  the  word  "Elements"  for  that  of  "  Manual,"  and  with  the  author's  sanction 
the  title  of  "Elements"  is  still  retained  as  being  more  expressive  of  the  scope  of  the  treatise. 


To  say  that  it  is  the  best  manual  of  Physiology 
now  before  the  public,  would  not  do  sufficient  justice 
to  the  author. — Buffalo  Medical  Journal. 

In  his  former  works  it  would  seem  that  he  had 
exhausted  the  subject  of  Physiology.  In  the  present, 
he  gives  the  essence,  as  it  were,  of  the  whole. — N.  Y. 
Journal  of  Medicine. 


Those  who  have  occasion  for  an  elementary  trea- 
tise on  Physiology,  cannot  do  better  than  to  possess 
themselves  of  the  manual  of  Dr.  Carpenter.— iftfetiicai 
Examiner. 

The  best  and  most  complete  expose  of  modera 
Physiology,  in  one  volume,  extant  in  the  English 
language. — St.  Louis  Medical  Journal. 


BY  THE   SAME   AUTHOR. 


PRINCIPLES  OP  COMPARATIVE   PHYSIOLOGY.     New  American,  from 

the  Fourth  and  Revised  London  edition.     In  one  large  and  handsome  octavo  volume,  with  over 
three  hundred  beautiful  illustrations,    pp.  752.     Extra  cloth,  $4  SO ;  leather,  raised  bands,  $5  20. 


This  book  should  not  only  be  read  but  thoroughly 
studied  by  every  member  of  the  profession.  None 
are  too  wise  or  old,  to  be  benefited  thereby.  But 
especially  to  the  younger  class  would  we  cordially 
commend  it  as  best  fitted  of  any  work  in  the  English 
language  to  qualify  them  for  the  reception  and  com- 
prehension of  those  truths  which  are  daily  being  de- 
veloped in  physiology. — Medical  Counsellor. 

Without  pretending  to  it,  it  is  an  encyclopedia  of 
the  subject,  accurate  and  complete  in  all  respects — 
a  truthful  reflection  of  the  advanced  state  at  which 
the  science  hag  now  arrived. — Dublin  Quarterly 
Journal  of  Medical  Science. 

A  truly  magnificent  work — in  itself  a  perfect  phy- 
siological study. — Ranking's  Abstract. 

This  work  stands  without  its  fellow.  It  is  one 
few  men  in  Europe  could  have  undertaken;  it  is  one 


no  man,  we  believe,  could  have  brought  to  so  suc- 
cessful an  issue  as  Dr.  Carpenter,  ft  required  for 
its  production  a  physiologist  at  once  deeply  read  in 
the  labors  of  others,  capable  of  taking  a  general, 
critical,  and  unprejudiced  view  of  those  labors,  and 
of  combining  the  varied,  heterogeneous  materials  at 
his  disposal,  so  as  to  form  an  harmonious  whole. 
We  feel  that  this  abstractcan  give  the  reader  a  very 
imperfect  idea  of  the  fulness  of  this  work,  and  no 
idea  of  its  unity,  of  the  admirable  manner  in  which 
material  has  been  brought,  from  the  most  various 
sources,  to  conduce  to  its  completeness,  of  the  lucid- 
ity of  the  reasoning  it  contains,  or  of  the  clearness 
of  language  in  which  the  whole  is  clothed.  Not  the 
profession  only,  but  the  scientific  world  at  large, 
must  feel  deeply  indebted  to  Dr.  Carpenter  for  this 
great  w^ork.  It  must,  indeed,  add  largely  even  to 
his  nigh  reputation. — Medical  Tinus. 


BY  THE  SAME  AUTHOR.     (Preparing.) 

PRINCIPLES  OP   GENERAL   PHYSIOLOGY,    INCLUDING   ORGANIC 

CHEMISTRY  AND  HISTOLOGY.     With  a  General  Sketch  of  the  Vegetable  and  Animal 
Kingdom.     In  one  large  and  very  handsome  octavo  volume,  with  several  hmidred  illustrations. 

BY  THE  SAME   AUTHOR. 

A  PRIZE  ESSAY  ON  THE  USE  OP  ALCOHOLIC  LIQUORS  IN  HEALTH 

AND  DISEASE.    New  edition,  with  a  Preface  by  D.  F.  Condie,  M.  D.,  and  explanations'  of 
scientific  words.    In  one  neat  12iuo.  Tolume,  extra  cloth,    pp.  178.    50  cents. 


BLANCHAKD  &  LEA'S  MEDICAL 


CONDIE  (D.  F.),  M.  D.,  &c. 
A  PRACTICAL  TREATISE  ON  THE  DISEASES  OF  CHILDREN.    Fifth 

edition,  revised  and  augmented.    In  one  large  volume,  8vo.,  leather,  of  over  750  pages.  $3  25. 

{Just  Issued,  1859.) 

In  presenting  a  new  and  revised  edition  of  this  favorite  work,  the  publishers  have  only  to  state 
that  the  author  has  endeavored  to  render  it  in  every  respect  "a  complete  and  faithful  exp)sition  of 
the  pathology  and  therapeutics  of  the  maladies  incident  to  the  earlier  stages  of  existence — a  full 
and  exact  account  of  the  diseases  of  infancy  and  childhood."  To  accomplish  this  he  has  subjected 
the  whole  woik  to  a  careful  and  thorough  revision,  rewriting  a  considerable  portion,  and  adding 
several  new  chapters.  In  this  manner  it  is  hoped  that  any  deliciencies  which  may  have  previously 
existed  have  been  supplied,  that  the  recent  labors  of  practitioners  and  observers  have  been  tho- 
roughly incorporated,  ai  d  that  in  every  point  the  work  will  be  found  to  maintain  the  high  reputation 
it  has  enjoyed  as  a  complete  and  thoroughly  practical  book  of  reierence  in  infantile  aflectious. 

A  few  notices  of  previous  editions  are  subjoined. 


Dr.  Condie's  scholarship,  acumen,  industry,  and 
practical  sense  are  manifested  in  this,  as  in  all  his 
numerous  contributions  to  science. — Dr.  Holmes's 
Report  to  the  American  Medical  Association. 

Taken  as  a  whole,  in  our  judgment,  Dr.  Condie*s 
Treatise  is  the  one  from  the  perusal  of  w^hieh  the 
praetiticmer  in  this  country  will  rise  with  the  great- 
est satisfaction. — Western  Journal  of  Medicine  and 
Surgery. 

One  of  the  best  works  upon  the  Diseases  of  Chil- 
dren in  the  English  language. —  Western  Lancet. 

We  feel  ussurad  from  actual  experience  that  n< 
physician's  library  can  be  ccimplete  without  a  cop) 
of  this  work. — A'.  Y.  .Tournnl  of  Medicine. 

A  veritable  paediatric  eneyclopsedui,  and  an  honoi 
to  American  medical  literature. — Ohio  Medical  and 
Surgical  Journal. 

We  feel  persuaded  that  the  American  medical  pro 
fesaion  will  soon  regard  it  not  only  as  a  very  good 
but  as  the  vbry  best  "Practical  Treatise  on  tli» 
Diseases  of  Children." — American  Medical  Journal 


We  pronounced  the  first  edition  to  be  the  beat 

work  on  the  diseases  of  children  in  the  English 
language,  and,  notwithstanding  all  that  has  been 
published,  we  still  regard  it  in  that  light. — Medical 
Examiner. 

The  value  of  works  by  native  authors  on  the  dis- 
eases which  the  phvsician  is  called  upon  to  combat, 
will  be  appreciated  by  all ;  an  I  the  work  of  Dr  Con- 
die  hasg>4ined  for  itself  the  character  of  a  sale  guide 
lor  students,  and  a  useful  work  for  consultation  by 
those  engaged  in  practice. — N.  Y.  Med    Times. 

This  IS  the  fourth  edition  of  this  deservedly  popu- 
lar treatise.  During  the  interval  since  the  last  edi- 
tion, it  has  been  subjected  to  a  thorough  revision 
by  the  author;  and  all  new  observations  in  the 
pathology  and  therapeutics  of  children  have  been 
included  in  the  present  volume.  As  we  said  bi  fore, 
we  uo  not  know  of  a  better  book  on  diseases  of  chil- 
dren, and  to  a  l.irge  part  o(  its  recommendations  we 
yield  un  unhesitatiog  concurrence. — Buffalo  Med. 
Tournal. 

Perhaps  the  most  full  and  complete  work  now  be- 


I 


In  the  department  of  int'antile  therapeutics,  the  ore  the  profession  of  the  United  States;  indeed,  we 
work  of  Dr.  Conuie  is  considered  one  or  the  best  nay  say  in  the  English  language.  It  is  vastly  supe- 
wliich  has  been  published  in  the  English  language,  "ior  to  moslof  itspredecessors. — Transylvania  Med . 
— The  Stethoscope,  Ijournal 


CHRISTISON   (ROBERT),  M.  D.,  V.  P.  R.  S.  E.,  Ac. 

A  DISPENSATORY;  or,  Commentary  on  the  Pharmacopoeias  of  Great  Britain 

and  the  United  States;  comprising  the  Natural  History,  Description,  Chemistry,  Pharmacy,  Ac- 
tionsj,  Uses,  and  Uoses  of  the  Articles  of  the  Materia  Medica.  Second  edition,  revised  and  im- 
proved, with  a  Supplement  containing  the  most  important  New  Remedies.  With  copious  Addi- 
tions, and  two  hundred  and  thirteen  large  wood-engravings.  By  R.  Eglesfeld  Griffith,  M.  D. 
In  one  very  large  and  handsome  octavo  volume,  leather,  raised  bands,  of  over  1000  pages.  $3  50. 


I 


COOPER  (BRANSBY   B.),  F.  R.  S. 

LECTURES  ON  THE   PRINCIPLES  AND   PRACTICE  OF   SURGERY. 

in  one  very  large  octavo  volume,  extra  cloth,  of  750  pages.    $3  00. 


COOPER  ON  DISLOCATIONS  AND  FRAC- 
TURES OF  THE  JOINTS  —Edited  by  Bransbt 
B.  Cooper,  F.  R.  S.,  ice.  With  additional  Ob- 
servations by  Prof.  J.  C.  Warren.  A  new  Ame- 
rican editiim.  In  one  handsome  octavo  volume, 
e.xtra  cloth,  of  about  501)  pages,  with  numerous 
illustrations  on  wood.     S3  '25. 

COOPER  ON  THE  ANATOMY  AND  DISEASES 
OF  THE  BREAST,  with  twenty-five  .Miscellane- 
ous and  Surgical  Papers.  One  large  volume,  im- 
perial bvo.,  extra  cloth,  with  25a  figures,  on  36 
plates      «-2  50. 

COOPER  ON  THE  STRUCTURE  AND  DIS- 
EASES OF  THE  TESTIS,  AND  ON  THE 
TH\  MUS  (iLA.ND.  One  vol.  imperial  tvo.,  ex- 
tra cloth,  with  177  figures  on  29  plates.    €2  00. 


COPLAND  ON  THE  CAUSES,  NATURE,  AND 
TREAT.MENT  OF  PALSY  AND  APOPLEXY. 
In  one  volume,  royal  12mo,,  extra  cloth,  pp.  326. 
60  cents. 

CLYAIER  ON  FEVERS;  THEIR  DIAGNOSIS, 
PATHOLOGY,   AND    TREATMENT      In   one 

octavo  volume,  leather,  of  600  pages.     $1  50. 

COLO.MBAT  DE  L'lSERE  ON  THE  DISEASES 
OF  FEMALES,  and  on  the  special  Hygiene  of 
their  Sex.  Translated,  with  many  Notes  and  Ad- 
ditions, by  C.  D.  Meigs,  M.D.  Secimd  edition, 
revised  and  improved  In  one  large  volume,  oc- 
tavo, leather,  with  numerous  wood-cuts.  pp.  720. 
m  SO. 


CARSON   (JOSEPH),  M.  D., 

Professor  of  Materia  Medica  and  Pharmacy  in  the  University  of  Pennsylvania. 

SYNOPSIS  OF  THE  COURSE  OF  LECTURES  ON  MATERIA  MEDICA 

AND  PHARiVIACY,  delivered  in  the   University  of   Pennsylvania     Second  and  revised  edi- 
tion,    lu  one  very  neat  octavo  volume,  extra  ciolh,  of  208  pages.     $1   50. 

CURLING    (T.     BJ,    F.  R.S,, 

Surgeon  to  the  London  Hospital,  President  of  the  Hunterian  Society,  4.C. 

A  PRACTICAL  TREATISE  ON  DISEASES  OF  THE  TESTIS,  SPERMA- 

TIC  CORD,  AND  SCROTUM.     Second  American,  troin  the  second  and  enlarged  English  edi- 
tion.   In  one  handsome  octavo  volume,  extra  cloth,  with  numerous  lilusiraiions.  pp.  4:;iO.  $2  00. 


AND    SCIENTIFIC    PUBLICATIONS. 


CHURCHILL  (FLEETWOOD),  M.  D.,  M.  R.  I.  A. 
ON  THE  THEORY  AND  PRACTICE  OF  MIDWIFERY.     A  new  American 

from  the  fourth  revised  and  enlarged  London  edition.  With  Notes  and  Additions,  by  D  Francis 
UoNDiE,  Nl.  D.,  author  oi  a  "Practical  Treatise  on  the  Diseases  of  Children,"  &c.  With  194 
illustrations  In  one  very  handsome  octavo  volume,  leather,  of  nearly  700  large  na<'es  $3  50 
(Now  Ready,  October,  1860.)  -    f  o  -w        . 

This  work  has  been  so  long  an  established  favorite,  both  as  a  fext-biok  for  the  learner  and  as  a 
reliable  aid  in  consul'aiion  tor  the  practitioner,  thul  in  presenting  a  new  edition  it  is  only  necessary 
to  call  attention  to  the  very  extended  improvements  which  it  has  received.  Having  had  the  benefit 
of  two  revisions  by  the  amhor  since  the  last  American  reprint,  it  has  been  materially  enlarsed,  and 
Dr.  Churchill's  well-known  conscientious  industry  is  a  guarantee  that  everv  portion  has  been  tho- 
roughly brought  up  with  the  latest  results  of  European  investigation  in  all  departments  of  the  sci- 
ence and  art  of  obstetrics.  The  recent  date  of  the  last  Dublin  edition  has  not  left  much  of  novelty 
for  the  American  editor  to  introduce,  but  he  has  endeavored  to  insert  whalevir  has  since  appeared, 
together  Vi^iih  such  matters  as  his  experience  has  shown  him  would  be  desirable  for  the  Amsrican 
student,  including  a  large  number  of  illustrations.  Wiih  the  sanction  of  the  author  he  has  added 
in  the  form  of  an  appendix,  some  chapters  from  a  little  "Manual  for  jNIidwive-  and  Nurses,"  re- 
cently is-ued  by  Dr.  Churchill,  believing  that  the  details  there  presented  can  hardly  fail  to  prove  of 
advantage  to  the  junior  practitioner.  Tne  result  of  all  these  additions  is  that  the  work  now  con- 
tains fully  one-half  more  matter  than  the  last  American  edition,  with  nearly  one-half  more  illus- 
trations, so  that  n  >twithstanding  the  use  of  a  smaller  type,  the  volume  contains  almost  two  hundred 
pages  more  than  before. 

No  effort  has  been  spared  to  secure  an  improvement  in  the  mechanical  execution  of  the  work 
equal  to  that  which  the  text  has  received,  and  the  volume  is  confidently  presented  as  one  of  the 
handsomest  that  has  thus  far  been  laid  before  the  American  profession;  while  the  very  low  price 
at  which  it  is  offered  should  secure  for  it  a  place  in  every  lecture-room  and  on  every  office  table. 


A  better  book  in  which  to  learn  these  important 
points  we  have  not  met  than  Dr.  Churchill's.  Every 
page  of  it  is  full  of  instruction  ;  the  opinion  of  all 
writers  of  authority  is  given  on  questions  of  ditfi- 
culty,  as  well  as  the  directions  and  advice  of  the 
learned  autaor  himself,  to  which  he  adds  the  result 
of  statiBtical  inquiry,  putting  statistics  in  their  pio 
per  place  and  giving  them  tlieir  due  weight,  and  no 
more.  We  have  never  read  a  bonk  more  free  from 
professinnal  jealousy  than  Dr.  Churchill's.  It  ap- 
pears to  be  written  with  the  true  design  of  a  book  on 
medicine,  viz  :  to  give  all  that  is  known  on  the  sub- 
ject of  which  he  treats,  both  theoretically  and  prac- 
tically, and  to  advance  such  opinions  of  nis  own  as 
he  believes  will  benefit  mtdical  science,  and  insure 
the  safety  of  the  patient.  We  have  said  enough  to 
convey  to  the  profession  that  this  book  of  Dr.  Cnur- 
cnill's  is  admirably  suited  for  a  book  of  reference 
for  the  practitioner,  as  well  as  a  text-book  for  the 
student,  and  we  hope  it  may  be  extensively  pur- 
chased amongst  our  readers.  To  them  we  most 
stronsly  recommend  it.  —  Dublin  Medical  Press, 
June '20,  IS60. 

To  bestow  praise  on  a  book  that  has  received  such 
marked  approbation  would  be  superfluous.  We  need 
only  say,  therefore,  that  if  the  first  edition  was 
thought  worthy  of  a  favorable  reception  by  the 
medical  public,  we  can  confidently  affirm  that  this 
will  be  found  much  more  so.  The  lecturer,  the 
practitioner,  and  the  student,  may  all  have  recourse 
to  its  pages,  and  derive  from  their  perusal  much  in- 
terest and  instruction  in  everything  relating  to  theo- 
retical and  practical  midwifery. — Dublin  Quarterly 
Journal  of  Medical  Science. 

A  work  of  very  great  merit,  and  such  as  we  can 
confidently  recommend  to  the  study  of  every  obste- 
tric practitioner. — London  Medical  Gazette. 

This  is  certainly  the  most  perfect  system  extant. 
It  is  the  best  adapted  for  the  purposes  of  a  text- 
book, and  that  which  he  whose  necessities  confine 
him  to  one  book,  should  select  in  prel'erence  to  all 
others. — Southern  Medical  and  Surgical  Journal. 

BY   THE   SAME   AUTHOR 


The  most  popular  work  on  midwifery  ever  issued 
'rom  the  American  press. — Charleston  Med.  Journal. 

Were  we  reduced  to  the  necessity  of  having  but 
me  work  on  midwifery,  and  permitted  to  choose, 
ve  M^ould  unhesitatingly  take  Churchill. —  Western 
Med.  and  Surg.  Journal. 

It  is  impossible  to  conceive  a  more  useful  and 
ilegant  manual  than  Dr.  Churchill's  Practit:e  of 
Vlidwifery. — Provincial  Medical  Journal. 

Certainly,  in  our  opinion,  the  very  best  work  on 
he  subject  which  exists. — N.  Y.  Annalist. 

No  work  holds  a  higher  position,  or  is  more  de- 
serving of  being  placed  in  the  hands  of  the  tyro, 
the  advanced  student,  or  the  practitioner. — Medical 
Examiner. 

Previous  editions,  under  the  editorial  supervision 
of  Prof  R.  M.  Huston,  have  been  received  with 
marked  favor,  and  they  deserved  it;  but  this,  i;e- 
printed  from  a  very  late  Dublin  edition,  carefuMy 
revised  and  brought  up  by  the  author  to  the  present 
time,  does  present  an  unusually  accurate  and  able 
exposition  of  every  important  particular  embraced 
in  the  department  of  midwifery.  *  *  The  clearness, 
directness,  and  precision  of  its  teachings,  together 
with  the  great  amount  of  statistical  research  whieh 
its  text  exhibits,  have  served  to  place  it  already  in 
the  foremost  rank  of  works  in  this  department  of  re- 
medial science. — N.  O.  Med.  and  Surg.  Journal. 

In  our  opinion,  it  forms  one  n{  the  best  if  not  the 
very  best  text-book  and  epitome  of  obstetric  science 
which  w^e  at  present  possess  in  the  Hnglish  lan- 
guage.— Monthly  Journal  of  Medical  Science. 

The  clearness  and  precision  of  style  in  which  it  is 
written,  and  the  greatamount(>f  statistical  research 
which  it  contains,  have  served  to  phn-e  it  in  the  first 
rank  of  works  in  this  departmentof  medical  science. 
—  N.  Y.  Journal  of  Medicine. 

Few  treatises  will  be  found  better  adapted  as  a 
text-book  for  the  student,  or  as  a  manual  for  the 
frequent  consultati<m  of  the  young  practitioner. — 
American  Medical  Journal. 


(Lately  Published.) 

ON  THE  DISEASES  OF  INFANTS   AND  CHILDREN.     Second  American 

Edition,  revised  and  enlarged  by  the  author.  Edited,  with  Notes,  by  W.  V.  Keating,  M.  D.  In 
one  large  and  handsome  volume,  extra  cloth,  of  over  700  pages.  $3  00,  or  in  leather,  $3  '25. 
In  preparing  this  work  a  second  time  for  the  American  profession,  the  author  has  spared  no 
labor  in  giving  it  a  very  thorough  revision,  introducing  several  new  chapters,  and  rewriting  others, 
while  every  portion  of  the  volume  has  been  subjected  to  a  severe  scrutiny.  The  etforis  of  the 
American  editor  have  been  directed  to  supplying  such  information  relative  to  matters  peculiar 
to  this  country  as  might  have  escaped  l»he  attention  of  the  author,  and  the  whole  may,  there- 
fore, be  safely  pronounced  one  of  the  most  complete  works  on  the  subject  accessible  to  the  Ame- 
rican Profession.  By  an  alteration  in  the  size  of  the  page,  these  very  extensive  additions  have 
been  accommodated  without  unduly  increasing  the  size  of  the  work. 

BY  THE   SAME  AUTHOR. 

ESSAYS  ON  THE  PUERPERAL  FEVER,  AND  OTHER  DISEASES  PE- 

CULIAR  TO  WOMEN.    Selected  from  the  writingsof  British  Authors  previous  to  the  close  o( 
the  Eighteenth  Century.    In  one  neat  octavo  volume,  extra  cloth,  of  about  450  pages.    $2  50. 


10  BLANCHARD    &    LEA'S   MEDICAL 

CHURCHILL  (FLEETWOOD),    M.  D.,  M .  R.  I.  A.,    ice. 
ON  THE  DISEASES  OP  WOMEN;  including  those  of  Pregnancy  and  Child- 
bed.   A  new  American  edition,  revised  by  the  Author.    With  Notes  and  Additions,  by  D   Fran- 
cis CoNDiE,  M.  D.,  author  ol  "A  Practical  Treatise  on  the  Diseases  of  Children."    With  nume- 
rous illustrations.    In  one  large  and  handsome  octavo  volume,  leather,  of  768  pages.    $3  00. 
This  edition  of  Dr.  Churchill's  very  popular  treatise  may  almost  be  termed  a  new  work,  so 
thoroughly  has  he  revised  it  in  every  portion.     It  will  be  found  greatly  enlarged,  and  completely 
brought  up  to  the  mo'rt  recent  condition  ol  the  subject,  while  the  very  liandfome  series  of  illustra- 
tions introduced,  representing  such  pathological  conditions  as  can  be  accurately  portrayed,  present 
a  novel  feature,  and  afford  valuable  assistance  to  the  young  practitioner.     Such  additions  as  ap- 
peared desirable  for  the  American  student  have  been  made  by  the  editor.  Dr.  Condie,  while  a 
marked  improvement  in  the  mechanical  execution  keeps  pace  with  the  advance  in  all  other  respects 
which  the  volume  has  undergone,  while  the  price  has  been  kept  at  the  former  very  moderate  rate. 
It  comprises,  unquestionably,  one  of  the  most  ex-  }  extent  that  Dr.  Churchill  does.    His,  indeed,  is  the 
act  and  comprehensive  exposititms  of  the  present  j  only  thoroueh  treatise  we  know  of  ctn  the  subject; 
stateof  medical  knowledge  in  respect  to  the  diseases  J  and  it  may  be  commended  to  practitioners  and  stu- 


of  women  that  has  yet  been  published. — Am.  Joum 
Med.  Sciences. 

This  work  is  the  most  reliable  which  we  possess 
on  this  subject;  and  is  deservedly  popular  with  the 
profession. — Charleston  Med.  Journal,  July,  1S37. 

We  know  of  no  author  who  deserves  that  appro- 
bation, on  "the  diseases  of  females,"  to  the  same 


dents  as  a  masterpiece  in  its  particular  department. 
—  Tkt  Western  Journal  of  Medicine  and  Surgery. 

As  a  comprehensive  manual  for  students,  or  a 
work  of  reference  for  practitioners,  it  surpasses  any 
other  that  has  ever  issued  on  the  same  subject  from 
the  British  press. — Dublin  Quart.  Journal. 


DICKSON   (S.    H.),    M.  D., 

Professor  of  Practice  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 

ELEMENTS  OF  MEDICINE;    a  Compendious  View  of  Pathology  and  Thera- 

peutics,  or  the  History  and  Treatment  of  Diseases.  Second  edition,  revi.>ed.  In  one  large  and 
handsome  octavo  volume,  of  750  pages,  leather.     $3  70.     {Just  Issued.) 

The  steady  demand  which  has  so  soon  exhausted  the  first  edition  of  this  work,  sufficiently  shows 
that  the  author  was  not  mistaken  in  suppo-;ing  that  a  volume  of  this  characier  was  needeii — an 
elemeniary  manual  of  practice,  which  should  present  the  leading  principles  of  medicine  with  the 
practical  results,  in  a  condensed  and  perspicuous  manner.  Disencumbered  of  unnecessary  detail 
and  fruitless  speculations,  it  embodies  what  is  most  requisite  for  the  student  to  learn,  and  at  the 
same  time  what  the  active  practitioner  wants  when  obliged,  m  the  daily  calls  of  his  profession,  to 
refresh  his  memory  on  special  points.  The  clear  and  attractive  style  of  the  author  renders  the 
whole  ea-y  of  comprehension,  while  his  long  experience  gives  to  his  teachings  an  authority  every- 
where acknowledged.  Few  physicians,  indeed,  have  had  wider  opportunities  (or  observation  and 
experience,  and  few,  perhaps,  have  used  them  to  lielter  purpose.  As  the  result  of  a  long  life  de- 
voied  to  study  and  practice,  the  present  edition,  revised  and  brought  up  to  the  date  of  puhlicalion, 
will  doubtless  maintain  the  reputation  already  acquired  as  a  condensed  and  convenieut  American 
text-book  on  the  Practice  of  Medicine. 

DRUITT   (ROBERT),   M.R.C.S.,   &.C. 
THE  PRINCIPLES  AND  PRACTICE  OF  MODERN  SURGERY.     A  new 

and  revi^ed  American  from  the  eighth  enlarged  and  improved  London  edition.  Illustrated  with 
four  hundred  and  thirty-tsvo  wood-ensrravings  In  one  very  handsomely  prmted  octavo  volume, 
leather,  of  nearly  700  laige  pages.     $3  50.     {Noiv  Ready,  October,  1660.) 

A  work  which  like  Druitt's  Surgery  has  for  so  many  years  mninlalned  the  position  of  a  lead- 
ing favorite  with  all  classes  of  the  profession,  needs  no  special  recommendation  to  attract  attention 
to  a  revi.-ed  edition.  It  is  only  necessary  to  slate  that  the  author  has  spared  no  pains  to  keep  the 
work  up  to  its  well  earned  reputation  of  presenting  in  a  small  and  convenient  compass  the  latest 
condition  of  every  deparlinent  ol  surgery,  considered  both  as  a  science  and  as  an  art;  and  that  the 
services  of  a  competent  American  editor  have  been  employed  to  introduce  whatever  novelties  may 
have  escapfd  the  author's  attention,  or  may  prove  ol  service  to  the  American  practitioner.  As 
several  editions  have  appeared  in  London  since  the  issue  of  the  last  American  reprint,  the  volume 
has  had  the  benefit  of  rei>eatcd  revisions  by  the  author,  resulting  in  a  very  tnorough  alteration  and 
improvement.  The  extent  of  these  additions  may  be  estimated  from  the  fact  that  it  now  contains 
about  one-third  more  matter  than  the  previous  American  edition,  and  that  notwithstanding  the 
adoption  of  a  smaller  type,  the  pages  iiave  been  increased  by  about  one  hundred,  while  nearly  two 
hundred  and  fifty  wood-cuts  have  been  added  to  the  former  list  of  illustrations. 

A  marked  i.nprovement  will  also  be  perceived  in  the  mechanical  and  artisiical  execution  of  the 
work,  which,  primed  in  the  best  style,  on  new  type,  and  fine  paper,  leaves  little  to  be  desired  as 
regards  external  finish;  while  at  the  very  low  price  affixed  it  will  be  found  one  of  the  cheapest 
Volumes  accessible  to  the  profession. 

This  popular  volume,  now  a  most  comprehensive  nothing  of  real  practical  importance  has  been  omit- 
work  on  surgery,  has  undergone  many  corrections,  ted;  it  presents  a  faithful  epitome  of  every  thine;  re- 
im  pro  Yemenis,  and  additions,  and  the  principles  and  la  ting  t  >  surgery  up  to  the  present  hour.  It  is  de- 
the  practice  of  the  art  have  been  brought  down  to  servedlv  a  popular  manual,  bolh  with  the  student 
the  latest  record  and  observation.  Of  the  r)perations  and  practitioner. — London  Lancet,  Nov.  19,  1859. 
in  snigtry  iiisimpossiblelofpeakloohii«hiy.     The'      t       ,     .        ,_  ■    i.  •  /•      .•  j 

descriptions  are  so  clear  and  concise,  and  the  illus-  '  ,  In  closing  this  brief  notice,  we  recommend  as  cor- 
t.ations  so  a-eurate  and  numerous,  that  the  student  ,  diallv  as  ever  this  most  utelul  and  compreheiiSive 
can  have  no  ditf.culty,  with  instrument  in  hand,  and  hand-bo,.k.  It  must  prove  a  vast  assittance,  not 
bcok  by  his  side,  over  the  dead  body,  in  obtaining-  '  ""'>'  '"  '^e  student  of  surgery,  but  also  to  the  busy 
a  proper  knowledge  and  sufficient  tact  in  this  mueh  '  practitioner  whi  may  not  have  the  leisure  tod'-vote 
Beglected  oepartmentof  medical  education.— /;r,<Ks/i  himself  to  the  study  of  more  lengthy  yolunies.- 
and  Foreign  Medico-Chirurg.  Review,  Jan.  ISCO        j  London  Med.  Times  and  Gazette,  Oi;t  22,  1M9. 

In  the  present  edition  the  author  has  entirelv  re-  j  In  a  word,  this  eighth  edition  of  Dr.  Druitt's 
■written  many  of  the  chapters,  and  has  incorpi.rat-d  ]  Manual  of  Surgery  is  all  that  the  surgical  student 
the  various  improvements  and  additions  in  modern  or  practitioner  could  desire.  —  Dublin  Quarterly 
surgery.    On  carefully  going  over  it,  we  find  that  |  Journal  of  Med.  Sciences,  Nov.  1859. 


AND    SCIENTIFIC    PUBLICATIONS. 


11 


DALTON,   JR.   (J.    C),    M .  D. 

Professor  of  Physiology  in  tlie  College  of  Physicians,  New  York. 

A  TREATISE  OX  HUMAN  PHYSIOLOGY,  designed  for  the  use  of  Students 

and  Practitioners  of  Medicine.  Second  edition,  revise-!  and  enlarged,  willi  two  bundled  and 
seventy-one  illustrations  on  wood.  In  one  very  beaniifnl  oclavo  volume,  of  700  na-^e-  extra 
cloth,  $4  00  ;  leather,  raised  bands,  $4  50.     {No^u  Ready,  March,  J861.)  y  a     ■, 

The  general  fiivor  which  has  so  soon  exhausted  an  edition  of  this  work  has  afforded  the  author 
an  opportunity  in  its  revision  of  supplying  the  dehciencies  which  existed  in  the  former  volume 
This  has  caused  the  insertion  of  two  new  .-hapters— one  on  the  Special  Senses,  the  other  on  Im- 
bibition, Exhalation,  and  the  Functions  of  the  Lymphatic  System— besides  numerous  a-lditions  of 
smaller  amount  scattered  through  the  work,  and  a  general  revision  deM^ned  lo  brina-  it  lhorou<'hlv 
up  to  the  present  condition  of  the  science  wilh  legdid  to  all  points  wnich  may  be""considered  as 
definilely  settled.  A  number  of  new  illustrations  has  been  introduced,  and  the  Work,  it  is  hoped 
in  its  improved  form,  may  continue  to  command  the  confidence  of  those  for  whose' use  it  is  in- 
tended. 


It  will  be  seen,  therefore,  that  Dr.  Dalton's  best  i  own  original  views  an'i  experiments  together  with 
ftr.rts  have  been  directed  towams  perfeciing  his  ;  a  desirelo  supply  whit  he  coi.sidereu  some  defirien- 
work.     The  additioriS  are  marked  b>  the  same  fta-       ■  ■      - 

tures  which  characterize  the  remainder  of  the  vol- 
ume, and  render  it  by  far  the  most  desirsble  text- 
book on  physiology  to  place  in  ihe  hands  of  the 
student  which,  so  far  as  we  are  aware,  exists 


the  English  language,  or  perhaps  in  any  other.  AVe 
iherefiire  have  no  hesitation  in  recommending  Dr. 
Dalton's  book  for  the  classes  for  which  it  is  intend- 
ed, satisfied  as  we  are  that  it  is  better  acapted  lo 
their  use  than  any  other  work  of  the  kind  to  which 
they  have  access. — American  Journal  of  the  Med. 
Sciences,  April,  1861. 

It  is,  therefore,  no  disparagemert  to  the  many 
books  upon  piiysiology,  most  excellent  in  their  day. 


cies  in  the  fiist  coition,  hav<  aiready  made  the  pre- 
sent one  a  ntctssity,  and  it  will  no  douht  he  even 
more  eagerly  soii!.lu  far  than  the  first.  That  it  is 
not  merely  a  reprint,  will  he  s-tn  from  the  author'* 
statement  of  the  foi  owing  priuci|)>il  Jidditions  and 
altera'ions  which  he  has  made.  The  present,  liKe 
the  first  edition,  is  printe'l  in  ihe  highest  style  of  Ihe 
pr'nter's  art,  and  the  illustiations  are  truly  admira- 
hle  tor  their  clparness  in  expressing  exactly  what 
their  author  intended.— i;os(o»  Medical  and  Surgi- 
cal Journal,  March  28,  IfcGt. 

It  is  unnecessary  to  eive  a  detail  of  the  additions ; 
suifice  It  to  say,  tliat  they  wre  nuinf-rons  acid  import- 
ant, and  such  as  will  render  llie  worK  still  m.ire 


to  say  that  Dalton's  is  the  only  one  that  gives  us  the  j  valuable  and  acceptable  to  the  profession  as  a  learn- 
Bcience  as  it  was  known  to  the  best  philosophers  I  ed  and  original  treatiseon  this  all-i,nportant  brHnch 
throughout  the  world,  at  the  beginning  of  the  cur-  [  of  medicine.  All  that  was  said  in  comintndaiion 
rent  year.  It  states  in  comprehensive  but  concise  I  of  the  getting  up  of  the  firstedition, and  the  superior 
diction,  the  facts  established  by  experiment,  or  |  style  of  the  illustratiims.  apply  with  equal  f'nce  to 
other  method  of  demonstration,  and  details,  in  an  tins.  No  better  work  on  physiology  cin  be  (jJaceU 
understandable  manner,  how  it  is  done,  but  abstains  :  in  the  hand  of  the  student. — St.  Louis  Medical  and 
Irom  thediscussion  of  unsettled  or  theoreticalp  lints.  1  Surgical  Journal,  j\Iay,  ISGl. 

Herein  it  is  unique;  and  these  characteristics  x,n  \  These  additions,  wh.le  tes  ifying  to  the  learning 
oer  It  a  text-bo(,k  wi  hout  a  riv,il,  for  those  who  g^j  industry  of  the  author,  render  the  b..oK  exceed- 
desire  to  study  physiological  science  as  it  is  known  I  i,,g,y  ^s^fui    ^s  the  most  complete  expose  of  a  scj- 


to  its  most  successful  cultivators.  And  it  is  physi- 
ol  igy  thus  presented  that  lies  at  the  toundation  of 
correct  pathological  knowledge;  and  this  in  turn  is 
the  basis  of  rational  therapeutics;  so  that  pathjlo- 
py,  in  fact,  becomes  of  prime  importance  in  the 
proper  discharge  of  our  every-day  practical  duties. 
— Cincinnati  Lancet,  May,  IbGl. 

Dr.  Dalton  needs  no  word  of  praise  from  us.     He 


ence,  of  which  Dr.Dilton  is  doubtless  the  ablest 
re^)refentative  on  this  side  of  the  Atlantic. — iYew 
Orleans  Med    Times,  May,  1861. 

A  sf  cond  edition  of  this  deservedly  popular  work 
having  been  called  for  in  the  short  space  of  two 
years,  the  author  has  su|>|  lied  deficiencies,  whicii 
existed  in  the  former  volums,  and  has  thus  more 
completely  fulfilled  his  design  of  prescn  ing  ti>  the 
is  universally  recognizeu  as  among  the  first,  if  not  I  profession  a  reliable  and  precise  text  book,  and  <me 
the  verv  fiist,  of  American  pliysiologists  now  living,  j  which  we  consider  the  best  outline  tm  the  subiect 
The  first  edition  of  his  admirable  work  appeared  but  of  which  it  treats,  in  any  language. — N.  Atnerican 
two  years  since,  and  the  advance  of  science,  his  I  Medico-Ckirurg.  Review,  May,  ItGl. 


DUNGLISON,    FORBES,   TWEEDIE,   AND   CONOLLY. 
THE  CYCLOPEDIA  OF  PRACTICAL  MEDICINE:  comprising  Treatises  on 

the  Nature  and  Treatment  of  Diseases,  Materia  Medica,  and  Therapeutics,  Diseases  of  Women 
and  Children,  Medical  Jurisprudence,  &;c.  &c.  In  four  large  super-royal  octavo  volumes,  of 
3254  double-columned  pages,  strongly  and  handsomely  bound,  with  raised  bands.  $12  00. 
*^*  This  work  contains  no  less  than  four  hundred  and  eighteen  distinct  treatises,  contributed  by 
sixty-eight  distinguished  physicians,  rendering  it  a  complete  library  of  reference  for  the  country 
practitioner. 

I  The  editors  are  practitioners  of  established  repu- 
tatum,  and  the  list  of  contributors  embraces  many 
of  the  most  eminent  professors  and  teachers  of  Lon- 
don, Edinburgh,  Dublin,  and  Glasgow.  It  is,  in- 
deed, the  great  merit  oi  this  work  that  theprincipal 
articles  have  been  furnished  by  practitioners  who 


The  most  complete  work  on  Practical  Medicine 
extant;  or,  at' least,  in  our  language.— £M//a/o 
Medical  and  Surgical  Journal. 

For  reference,  it  is  above  all  price  to  every  prac- 
titioner.—  Western  Lancet. 


One  of  the  most  valuable  medical  publications  of  |  '"^ve  not  only  devotee  especial  atlenti.m  to  the  dis- 


the  day — as  a  work  of  reference  it  is  invaluable. — 
Western,  Journal  oj  Medicine  and  Surgery. 

It  has  been  to  us,  both  as  learner  and  teacher,  a 
work  for  ready  and  frequent  reference,  <me  in  which 
modern  English  medicine  is  exhibited  in  the  most 
advantageous  light. — Medical  Examiner . 


eases  about  which  the>  have  written,  but  have 
also  enjoyed  opportunities  for  an  extensive  practi- 
cal acquaintance  with  them  and  whose  reputation 
carries  the  assurance  of  their  competency  justly  lo 
appreciate  the  opinions  ol  others,  while  it  stamps 
their  own  doctrines  witl  high  and  just  authority. — 
American  Medical  Journal. 


DEWEES'S  COMPREHENSIVE  SYSTEM  OF 
MIDWIFERY.  Illustrated  by  occasional  cases 
and  many  engravings.  Twelfth  edition,  with  the 
author's  last  improvements  and  corrections  In 
oneoctavovolume,  extracloth,  of 600 pages.  S3 20. 


AND  MEDICAL  TREATMENT   OF    CHILD- 
REN.    The  last  edition     In  one  volume,  octavo, 
extra  cloth,  ai8  pages.     $'2  SO 
DEWEEl!;'S   TREATISE   ON    THE   DISEASES 
OF  FEMALES.     Teiilh  edition.     In  one  volume, 


DEWEES'S  TREATISE  ON   THE   PHYSICAL  I      octavo  extra  cloth,  532  pages,  with  plates.  83  00 


12 


BLANCHARD   &    LEA'S    MEDICAL 


DUNGLISON    (ROBLEY),    M.D., 

ProfessoT  of  Institutes  of  Medicine  in  the  Jefferson  Medical  College,  Philadelphia. 

NEW  AND  ENLARGED  EDITION. 

MEDICAL  LEXICON;   a  Dictionary  of  Medical  Science,  containing  a  concise 

Explanation  ofthe  various  Subjects  and  Terms  of  Anatomy,  Physiology,  Pathology,  Hygiene, 
Therapeutics,  Pharmacology,  Pharmacy,  Surgery,  Obstetrics,  Medical  Jurisprudence,  Dentistry, 
&:c.  Notices  of  Climate  and  of  Mineral  Waters;  Formulae  for  Oflicinal,  Empirical,  and  Dietetic 
Preparations,  ifec.  With  French  and  other  Synonymes.  Revised  and  very  greatly  enlarged. 
In  one  very  large  and  handsome  octavo  volume,  of  992  double-columned  pages,  in  small  type ; 
strongly  bound  in  leather,  with  raised  bands.    Price  $4  00. 

Especial  care  has  been  devoted  in  the  preparation  of  this  edition  to  render  it  in  every  respect 
worthy  a  continuance  of  the  very  remarkable  favor  which  it  has  hitherto  enjoyed.  The  rapid 
sale  of  Fifteen  large  editions,  and  the  constantly  increasing  demand,  show  that  it  is  regarded  by 
the  profession  as  the  standard  authority.  Stimulated  by  this  tact,  the  author  has  endeavored  in  the 
present  revision  to  introduce  whatever  might  be  necessary  "  to  make  it  a  satisfactory  and  desira- 
ble— if  not  indispensable — lexicon,  in  which  the  sludent  may  search  without  disappointment  for 
every  term  that  has  been  legitimated  in  the  nomenclature  of  the  science."  To  accomplish  this, 
large  additions  have  been  found  requisite,  and  the  extent  of  the  author's  labors  may  be  estimated 
from  the  fact  that  about  Six  Thousand  subjects  and  terms  have  been  introduced  throughout,  ren- 
dering the  whole  number  of  definitions  about  Sixty  Thousand,  to  accommodate  which,  the  num- 
ber of  pages  has  been  increased  by  nearly  a  himdred,  notwithstanding  an  enlargement  in  the  size 
of  thepaffe.  The  medical  press,  both  in  this  country  and  in  England,  has  pronounced  the  work  in- 
dispensable to  all  medical  students  and  practitioners,  and  the  present  improved  edition  will  not  lose 
that  enviable  reputation. 

The  publishers  have  endeavored  to  render  the  mechanical  execution  worthy  of  a  volume  of  such 
universal  use  in  daily  reference.  The  greatest  care  hns  been  exercised  to  obtain  the  typographical 
accuracy  so  necesi-ary  in  a  work  of  the  kind.  By  the  small  but  exceedingly  clear  type  employed, 
an  immense  amount  oJ  matter  is  condensed  in  its  thousand  ample  pages,  while  the  binding  will  be 
lound  strong  and  durable.  With  all  these  improvements  and  enlargements,  the  pricehas  been  kept 
at  the  former  very  moderate  rate,  placing  it  within  the  reach  of  all. 


This  work,  the  appearance  of  the  fifteenth  edition 
of  which,  it  has  become  our  duty  and  pleasure  to 
announce,  is  perhaps  the  most  stupendous  monument 
of  lahor  and  erudition  in  medical  literature.  One 
w^ould  hardly  suppose  after  constant  use  of  the  pre- 
ceding editions,  wliere  we  have  never  failed  to  find 
a  sufficiently  full  explanation  of  ever>  medical  term, 
that  in  tliis  edition  ^^  about  six  thousand  subjects 
and  terms  have  been  added,^^  with  a  careful  revision 
and  correction  of  the  entire  work.  It  is  only  neces- 
sary to  announce  the  advent  of  this  edition  to  m:ike 
it  occupy  the  place  of  the  preceding  one  on  the  table 
of  every  medical  man,  as  it  is  without  doubt  the  best 
and  most  comprehensive  work  of  the  kind  which  has 
ever  appeared. — Buffalo  Med.Journ.,  Jan.  1858. 

The  work  is  a  monument  of  patient  research, 
skilful  judgment,  and  vast  physical  labor,  that  will 
perpetuate  the  name  of  the  author  more  effectually 
than  any  possible  device  of  stone  or  metal.  Dr. 
Dunglison  deserves  the  thanks  not  only  ofthe  Ame- 
rican professiwn,  but  of  the  whole  medical  world. — 
North  Am.  Medico-Chir.  Reviexo,  Jan.  Ifc58. 

A  Medical  Dictionary  better  adapted  for  the  wants 
of  the  profession  than  any  other  with  wiiich  we  are 
acquainted,  and  of  a  character  which  places  it  far 
above  comparison  and  competition. — Am,.  Journ. 
Med.  Sciences,  Jan.  1858. 

We  need  only  say,  that  the  addition  of  6,000  new 
terms,  with  tlieir  accompanying  definitions,  may  be 
said  to  constitute  a  new  work,  by  itself.  We  have 
examined  the  Dictionary  attentively,  and  are  most 
happy  to  pronounce  it  unrivalled  of  its  kind.  The 
erudition  displayed,  and  the  extraordinary  industry 
which  must  have  been  demanded,  in  its  preparation 
and  perfection,  redound  to  the  lasting  credit  of  its 
author,  and  have  furnished  us  with  a  volume  indis- 
pensable at  the  present  day,  to  all  who  would  find 
themselves  au  niveau  with  the  highest  standards  of 
medical  information. — Boston  Medical  and  Surgical 
Journal,  Dec.  31,  la57. 

Good  lexicons  and  encyclopedic  works  generally, 
are  the  most  labor-saving  contrivances  which  lite- 
rary men  enjoy;  and  the  labor  which  is  required  to 
produce  them  in  the  perfect  manner  of  this  example 
is  something  appalling  to  contemplate.    The  author 


tells  us  in  his  preface  that  he  has  added  about  six 
thousand  terms  and  subjects  to  this  edition,  which, 
before,  was  considered  universally  as  the  best  work 
of  the  kind  in  any  language. — Silliman's  Journal, 
March,  lb58. 

He  has  razed  his  gigantic  structure  to  the  founda- 
tions, and  remodelled  and  reconstructed  the  entire 
pile.  No  less  than  six  thousand  additional  subjects 
and  terms  are  illustrated  and  analyzed  in  this  new 
edition,  swelling  the  grand  aggregate  to  beyond 
sixty  thousand  !  Thus  is  placed  before  the  profes- 
sion a  complete  and  thorough  exponent  of  medical 
terminology,  without  rival  or  possibility  of  rivalry. 
— Nashville  Journ.  of  Med.  and  Surg.,  Jan.  1858. 

It  is  universally  acknowledged,  we  believe,  that 
this  work  is  incomparably  the  best  and  most  com- 
plete Medical  Lexicon  in  the  English  language. 
The  amount  of  labor  which  thedislinp[uislied  author 
has  bestowed  upon  it  is  truly  wonderful,  and  the 
learning  and  research  displayed  in  its  preparation 
are  equally  remarkable.  Comment  and  commenda- 
tion are  unnecessary,  as  no  one  at  the  pr<»sent  day 
thinks  of  purchasing  any  other  Medical  Dictionary 
than  this. — St.  Louis  Med.  and  Surg.  Journ.,  Jan. 
1858. 

It  is  the  foundation  stone  of  a  good  medical  libra- 
ry, and  should  always  be  included  in  the  first  list  of 
books  purchased  by  the  medical  student. — Am.  Med. 
Monthly,  Jan.  1S58. 

A  very  perfect  work  of  the  kind,  undoubtedly  the 
most  perfect  in  the  English  language. — Med.  and 
Surg.  Reporter,  Jan.  1868. 

It  is  now  emphatically  the  Medical  Dictionary  of 
the  English  language,  and  for  it  there  is  no  substi- 
tute.—jV.  H.  Med.  Journ.,  Jan.  1858. 

It  is  scarcely  necessary  to  remark  that  any  medi- 
cal library  wanting  a  copy  of  Dunslison's  Lexicon 
must  be  imperfect. — Cin.  Lancet,  Jan.  1858. 

We  have  ever  considered  it  thebestauthority  pub- 
lished, and  the  present  edition  we  may  safely  say  has 
no  equal  in  the  world. — Peninsular  Med.  Journal, 
Jan.  1858. 

The  most  complete  authority  on  the  subject  to  be 
foundin  any  language. —  Va.Med.  Journal,  Feb.  '58. 


BY   THE  SAME   AUTHOK. 


THE  PRACTICE  OF  MEDICINE.     A  Treatise  on  Special  Pathology  and  The- 
rapeutics.   Third  Edition.    In  two  large  octavo  volumes,  leather,  of  1,500  pages.    $6  25. 


AND    SCIENTIFIC    PUBLICATIONS. 


13 


DUNGLISON    (ROBLEY),    M.D., 

Professor  of  Institutes  of  Medicine  in  tlie  Jefferson  Medical  College,  Philadelphia. 

HUMAN    PHYSIOLOGY.     Eighth   edition.      Thoroughly  revised  and  exten- 

sively  modified  and  enlarged,  with  five  hundred  and  thirty-two  illustrations.    In  two  laro-e  and 
handsomely  printed  octavo  volumes,  leather,  of  about  1500  pages.     $7  00.  ° 

In  revising  this  work  for  its  eighth  appearance,  the  author  has  spared  no  labor  to  render  it  worthy 
a  continuance  of  the  very  great  favor  which  has  been  extended  to  it  by  the  profession.  The  whole 
contents  have  been  rearranged,  and  to  a  great  extent  remodelled  ;  the  investigations  which  of  late 
years  have  been  so  numerous  and  so  important,  have  been  carefully  examined  and  incorpjraled 
and  the  work  in  every  respect  has  been  brought  up  to  a  level  with  the  present  slate  of  the  subject! 
The  object  of  the  author  has  been  to  render  it  a  concise  but  comprehensive  treatise,  containing-  the 
whole  body  of  physiological  science,  to  which  the  student  and  man  of  science  can  at  all  times  "refer 
with  the  certainty  of  finding  whatever  they  are  in  search  of,  fully  presented  in  all  its  aspects;  and 
on  no  former  edition  has  the  author  bestowed  more  labor  to  secure  this  result. 


We  believe  that  it  can  truly  be  said,  no  more  com- 
plete repertory  of  facts  upon  the  subject  treated, 
can  anywhere  be  found.  The  author  lias,  moreover, 
that  enviable  tact  at  description  and  that  facility 
and  ease  of  expression  which  render  him  peculiarly 
acceptable  to  the  casual,  or  the  studious  reader. 
This  faculty,  so  requisite  in  setting  forth  many 
graver  and  less  attractive  subjects,  lends  additional 
charms  to  one  always  fascinating. — Boston  Med. 
and  Surg.  Journal. 

The  most  complete  and  satisfactory  system  of 
Physiol()gy  in  the  English  language. — Amer.  Med. 
Journal . 


The  best  work  of  the  kind  in  the  English  lan- 
guage.— Sillitnan^s  Journal. 

The  present  edition  the  author  has  made  a  pel  feet 
mirror  of  the  science  as  it  is  at  tlie  present  hour. 
As  a  work  upon  physiology  proper,  the  science  of 
the  functions  performed  by  the  body,  the  student  will 
find  it  all  he  wiaiiea.—Naskville  Journ.  of  Med. 

That  he  has  succeeded,  most  admirably  succeeded 
in  his  purpose,  is  apparent  from  tlie  appearance  of 
an  eighth  edition.  It  is  now  the  great  encyclopoedia 
on  the  subject,  and  worthy  of  a  place  in  every  phy- 
sician's library. —  Western  Lancet. 


BY  THE  SAME  AUTHOR.     {A  new  edition.') 

GENERAL    THERAPEUTICS    AND    MATERIA  MEDICA;   adapted  for  a 

Medical  Text-book.  With  Indexes  of  Remedies  and  of  Diseases  and  their  Remedies.  Sixth 
Edition,  revised  and  improved.  With  one  hundred  and  ninety-three  illustrations.  In  two  large 
and  handsomely  printed  octavo  vols.,  leather,  of  about  1100  pages.    $6  00. 

In  announcing  a  new  edition  of  Dr.  Dunglison's 
General  Tlierapeutics  and  Materia  Medica,  we  have 
no  words  of  commendation  to  bestow  upon  a  work 
whose  merits  have  been  heretofore  so  often  and  so 
justly  extolled.  It  must  not  be  supposed,  however, 
that  the  present  is  a  mere  reprint  of  the  previous 
edition;  the  character  of  the  author  for  laborious 
research,  judicious  analysis,  and  clearness  of  ex- 
pression, is  fully  sustained  by  the  numerous  addi- 
tions he  h;is  made  to  the  work,  and  tne  careful  re- 
vision to  which  he  has  subjected  the  whole. — JV.  A. 
Medico-Chir.  Review,  Jan.  1658. 


The  work  will,  we  have  little  doubt,  be  bought 
and  read  by  the  majority  of  medical  students^  its 
size,  arrangement,  and  reliability  recommend  it  to 
all;  no  one,  we  venture  to  predict,  will  study  it 
without  profit,  and  there  are  few  to  whom  it  will 
not  be  in  some  measure  useful  as  a  work  of  refer- 
ence. The  young  practitioner,  more  especially,  will 
find  the  copious  indexes  appended  to  this  edi;ion  of 
great  assistance  in  the  selrction  and  preparation  of 
suitable  formulee. — Charleston  Med.  Journ.  and  Re- 
view, Jan. 1858. 


BY  THE  SAME  AUTHOR,     {A  new  Edition.) 

NEW  REMEDIES,  WITH  FORMULAE  FOR  THEIR  PREPARATION  AND 

ADMINISTRATION.     Seventh  edition,  with  extensive  Additions.    In  one  very  large  octavo 
volume,  leather,  of  770  pages.     $3  75. 

Another  edition  of  the  "  New  Remedies"  having  been  called  for,  the  author  has  endeavored  to 
add  everything  of  moment  that  has  appeared  since  the  publication  of  the  last  edition. 

The  articles  treated  of  in  the  former  editions  will  be  found  to  have  undergone  considerable  ex- 
pansion in  this,  in  order  that  the  author  might  be  enabled  to  introduce,  as  far  as  practicable,  the 
results  of  the  subsequent  experience  of  others,  as  well  as  of  his  own  observation  and  reflection  ; 
and  to  make  the  work  still  more  deserving  of  the  extended  circulation  with  which  the  preceding 
editions  have  been  favored  by  the  profession.  By  an  enlargement  of  the  page,  the  numerous  addi- 
tions have  been  incorporated  without  greatly  increasing  the  bulk  of  the  volume. — Preface. 


One  of  the  most  useful  of  the  author's  works. — 
Southern  Medical  and  Surgical  Journal, 

This  elaborate  and  useful  volume  should  be 
found  in  every  medical  library,  for  as  a  book  of  re- 
ference, for  physicians,  it  is  unsurpassed  by  any 
other  work  in  existence,  and  the  double  index  for 
diseases  and  for  remedies,  will  be  found  greatly  to 
enhance  its  value. — New  York  Med.  Gazettt. 


The  great  learning  of  the  author,  and  his  remark- 
able industry  in  pushing  his  researches  into  every 
source  whence  information  is  derivable, have  enabled 
him  to  throw  together  an  extensive  mass  of  facte 
and  statements,  accompanied  by  full  reference  to 
authorities;  which  last  fe.iture  renders  the  work 
practically  valuable  to  investicfators  who  desire  t« 
examine  the  original  papers. — Tke  American  Journal 
of  P  harmacy . 


ELLIS  (BENJAMIN),  M.D. 
THE   MEDICAL   FORMULARY :   being  a  Collection  of  Prescriptions,  derived 

from  the  writings  and  practice  of  many  of  the  most  eminent  physicians  of  America  ami  Europe. 
Together  with  the  usual  Dietetic  Preparations  and  Antidotes  for  Poisons.  To  whicli  i»  added 
an  Appendix,  on  the  Endermic  use  of  Medicines,  and  on  the  use  of  Ellier  and  Chloroform.  The 
whole  accompanied  with  a  few  brief  Pharmaceutic  and  Medical  Observations.  Tenth  edition, 
revised  and  much  extended  by  Robert  P.  Thomas,  M.  D.,  Professor  of  Materia  Medica  in  the 
Philadelphia  College  of  Pharmacy.    In  one  neat  octavo  volume,  extra  cloth,  of '.^96  pages.    $1  75. 


14 


BLANCHARD    &   LEA'S    MEDICAL 


ERICHSEN    (JOHN), 

Professor  of  Surgery  in  University  College,  London,  4;C. 

THE  SCIENCE  AND  ART  OF  SURGERl^;  being  a  Treatise  on  SimaiCAL 

Injuries,  Diseases,  and  Operations.    New  and  improved  American,  from  the  second  enlarged 

and  carefully  revised  London  edition.     Illustrated  with  over  four  hundred  engravings  on  wood. 

In   one  large  and  handsome  octavo  volume,  of  one  thousand  closely  printed  pages,  leather, 

raised  bands.     $4  50.     [Just  Issued.) 

The  very  distinguished  favor  with  which  this  work  has  been  received  on  both  sides  of  the  Atlan- 
tic has  stimulated  the  author  to  render  it  even  more  worthy  of  the  position  which  it  has  so  rapidly 
attained  as  a  standard  authority.  Every  portion  has  been  carefully  revised,  numerous  additions 
have  been  made,  and  the  most  watchful  care  has  been  exercised  to  render  it  a  complete  exponent 
of  the  most  advanced  condition  of  surgical  science.  In  this  manner  the  work  has  been  enlarged  by 
about  a  hundred  pages,  while  the  series  of  engravings  has  been  increased  by  more  than  a  hundred, 
rendering  it  one  of  the  most  thoroughly  illustrated  volumes  before  the  profession.  The  additions  of 
the  author  having  rendered  unnecessary  most  of  the  notes  of  the  former  American  editor,  but  little 
has  been  added  in  this  country;  some  few  notes  and  occasional  illustrations  have,  however,  been 
introduced  to  elucidate  American  modes  of  practice. 

It  is,  in  our  humhle  judgment,  decidedly  the  best  j  step  of  the  operation,  and  not  deserting  him  until  the 


book  of  the  kind  in  the  English  language.  Strange 
that  just  such  l)ooks  are  notoflener  produced  by  pub 
lie  teachers  of  surgery  in  this  country  and  Great 
Britain  Indeed,  it  Is  a  matter  of  great  astonishment 
but  no  less  true  than  astonishing,  thai  of  the  many 
works  on  surgery  repullished  in  this  country  within 
the  last  fifteen  or  twenty  years  as  text-hooks  for 
medical  studeius,  this  i.*  the  only  one  that  even  ap- 
proximates to  the  fulfilment  of  the  peculiar  wants  of 
young  men  just  entering  upon  ttip  «tudy  of  this  branch 
of  the  profession. —  Western  Jour  .of  Med.  ami  Surgery. 

Its  value  is  greatly  enhanced  by  a  very  copious 
well-arransed  index.  We  regard  this  as  one  of  the 
most  valuable  contributions  to  morlern  surgery.  To 
one  entering  his  novitiate  of  practice,  we  regard  it 
the  most  serviceable  guide  wlilcli  he  can  consult.  He 
will  find  a  t'ulness  of  detail  leadinghim  ihroLgh  every 


final  issue  of  the  case  is  decided. — Sethoscope. 

Embracing,  as  will  be  perceived,  ttie  whole  surgi- 
cal domain,  and  each  division  of  itself  almost  com- 
plete and  perfect,  each  chapierfull  and  explicit,  each 
subject  faithfully  exhibited,  we  can  only  express  oui 
estimate  of  it  in  the  aggregate.  We  consider  it  an 
excellent  contribution  to  surgery,  as  probably  the 
best  single  volume  now  extant  on  the  subject,  and 
with  greai  pleasure  we  add  it  to  our  text-books. — 
Nashville  Journal  of  Medicine  and  Surgery. 

Prof  Erichsen's  work,  for  its  size,  has  not  been 
surpassed;  his  nine  hundred  and  eight  pages,  pro- 
fusely illustrated,  are  rich  in  physiological,  patholo- 
gical, and  operative  suggestions,  doctrines,  details, 
and  processes;  and  will  prove  a  reliable  resource 
for  information,  both  in  physician  and  surceon,  in  the 
hour  of  peril. —  N.  0.  Med.  and  Surg.  Journal. 


FLINT  (AUSTIN),  M.  D., 

Professor  of  the  Theory  and  Practice  of  Medicine  in  the  University  of  Louisville,  &.C. 

PHYSTCAL  EXPLORATION  AND  DIAGNOSIS  OF  DISEASES  AFFECT- 
ING THE  RESPlK.-\TORY  ORGANS.  In  one  large  and  handsome  octavo  volume,  extra 
cloth,  6.36  pages. 


$3  00. 
We  regard  it,  in  point  both  of  irrangement  and  of 
the  marked  abllitv  of  its  treatment  of  the  subiccts, 
as  destined  to  take  the  first  rank  in  works  of  this 
class.  So  far  as  our  inl'ormation  extends,  it  has  at 
present  no  equal.  To  the  practitioner,  as  well  as 
the  student,  it  will  be  invaluable  in  clearing  up  the 
diagnosis  of  doubtful  eases,  and  in  shedihnp  light 
upon  difficult  phenomena. — Buffalo  Med.  Journal. 


A  work  of  original  observation  of  the  highest  merit. 
We  recommend  the  treatise  to  every  one  who  wishes 
to  become  a  correct  auscultator.  Based  to  a  very 
large  extent  upon  cases  numerically  examined,  it 
carries  the  evidtnce  of  careful  study  and  discrimina- 
tion ui'on  every  pane.  It  does  credit  to  ttie  author, 
and  through  him,  to  the  profession  in  this  country. 
It  is,  what  we  cannot  call  every  book  upon  auscul- 
tation, a  readable  book. — Am.  Jour.  Med.  Sciences. 

BY  THE  SAME  ATTTHOR.      (NoW  Ready.) 

A  PRACTICAL  TREATISE  ON  THE  DIAGNOSIS,  PATHOLOGY,  AND 

TREATMENT  OF  DIJ^EASES  OF  THE  HEART.     In  one  neat  octavo  volume,  of  about 
500  pages,  extra  cloth.     $  I  Tfx 


We  do  no*  know  that  Dr.  Flint  has  written  any- 
thing which  is  not  first  rate  ;  but  this,  his  latest  con- 
tribution to  medical  literature,  in  our  opini(m,  sur- 
passes all  the  others.  The  work  is  mo.st  comprehen- 
sive in  its  scope,  and  most  sound  in  the  views  it  enun- 
ciatrs.  The  descriptions  are  clear  and  methodical; 
the  statements  are  substantiated  by  facts,  aid  are 
made  with  such  simplicity  and  sincerity,  that  witti- 


diseasps  of  the  chest.  VVe  have  adopted  his  work 
upim  the  heart  as  a  fcxt-book,  believing  it  to  be 
more  valuable  for  that  purpose  than  any  work  of  the 
kind  that  has  yet  appeared. — Kashville  Med.Journ., 
Dec.  1S.59. 

With  more  than  pleasure  do  we  hail  the  advent  of 
this  work,  for  it  fills  a  wide  gap  on  the  list  c  f  text- 
books for  our  scliools,  and  is,  lor  the  practitioner. 


out  them  they  would  carry  convic'ion.     The  style  |  ,|,e  n.„st  valu;.ble  practical  work  of  its  kind.— A'.  O 
is  admirably  clear,  direct,  and  free  from  dryness    |  jyjfcl^  J\'ewt   Nov.  1859 


With  Dr.  Walshe's  excellent  treaiise  before  us,  we 
have  no  hesitation  in  saj  in?  that  Dr.  Flint's  book  is 
the  best  work  (m  the  heart  in  the  English  language. 
— Boston  Med.  and  Surg.  Journal.,  Dec.  15,  ls59. 

We  have  thus  endeavored  to  present  our  readers 
w^ith  a  fair  analysis  ot  this  remarkable  work.  Pre- 
ferring to  employ  the  very  words  of  thedistinguished 
autiior,  wherever  it  was  possible,  we  have  essayed 
to  condense  into  the  briefest  spacea  general  view  of 
his  observations  and  suggestions,  and  to  direct  the 
attenti<m  of  our  brethren  to  the  abounding  stores  of 
valuable  matter  here  collected  and  arraiiged  for  their 
use  and  instruction.  No  mediea'  library  will  here 
after  be  considered  complete  without  ttiis  volume; 
and  we  trusf  it  will  promptly  find  its  way  info  the 
hands  of  every  Ame'ican  student  and  physician. — 
N   Am.  Med.  Chir.  Review,  Jan    1860. 

This  last  work  of  Prof.  Flint  will  add  much  to 
his  previous  well-earned  celebrity,  as  a  writer  ot 
great  forceand  beauty,  and,  wiih  his  previous  work, 
places  him  at  the  head  of  American  writers  upon 


In  regard  to  the  merits  of  the  work,  we  have  no 
hesi'utHm  in  pronouncing  it  full,  accurate,  and  ju- 
dicious. Considering  the  pres'nt  state  of  science, 
such  a  work  was  much  needed.  Jt  should  be  in  the 
hands  of  every  practitioner. — Chicago  Med.  Journal. 
April,  1860. 

But  these  are  verv  trivial  spots,  and  in  nowise 
prevent  us  from  declaring  our  most  hearty  approval 
of  the  author's  ability,  industry,  and  conscientious- 
ness.—  Dublin  Quarterly  Journal  of  Med.  Sciences, 
Feo.  1860. 

He  has  labored  on  wi'h  the  same  industry  and  care, 
and  his  place  among  the  Jirst  authors  of  our  country 
is  bec<Mning  fully  esiabliohed.  To  this  end,  the  work 
whose  title  is  given  above,  contributes  in  no  small 
degree.  Our  spa  :e  will  not  admit  of  »n  extended 
analysis,  nnd  we  will  close  this  urief  no'ice  by 
commending  it  without  reserve  to  every  class  of 
readers  in  the  profession. — Peninsular  Med.  Journ., 
Feb.  1800. 


AND    SCIENTIFIC    PUBLICATIONS. 


15 


FOWNES  (GEORGE),  PH.  D.,  &c. 
A  MANUAL  OF  ELEMENTARY  CHEMISTRY;  Theoretical  and  Practical. 

From  the  seventh  revised  and  correeted  Lond.m  edition.  With  one  hundred  and  ninety-<even 
illustrations.  Edited  by  Robert  Bridges,  M.  D.  In  one  large  royal  12mo.  volume  of  tiOO 
pages.     In  leather,  $1  65;  extra  cloth,  $1  50.     (Just  Issued.)  ' 

The  death  of  the  author  having  placed  the  editorial  care  of  this  work  in  the  practised  hands  of 
Drs.  Bence  Jones  and  A.  W.  Hoffman,  everything-  has  been  done  in  its  revision  which  experience 
could  suggest  to  keep  it  on  a  level  with  the  rapid  advance  of  chemical  science.  The  additions 
requisite  to  this  purpose  have  neces^ilated  an  enlargement  of  the  page,  notwithstanding  which  the 
work  has  been  increased  by  about  fifty  pages.  At  the  same  time  every  care  has  been  used  to 
maintain  its  distinctive  character  as  a  condensed  manual  for  the  student,  divested  of  all  unneces.sary 
detail  or  mere  theoretical  speculation.  The  additions  have,  of  course,  been  mainly  in  the  depart- 
ment of  Organic  Chemistry,  which  has  made  such  rapid  progress  within  the  last  kw  years,  but 
yet  equal  attention  has  been  bestowed  on  the  other  branches  of  the  subject— Chemical  Physics  and 
inorganic  Chemistry— to  present  all  investigations  and  discoveries  of  importance,  and  to  keep  up 
the  reputation  of  the  volume  as  a  complete  manual  of  the  whole  .science,  admirably  adapted  for  the 
learner.  By  the  use  of  a  small  but  exceedingly  clear  type  the  matter  of  a  large  octavo  is  compressed 
within  the  convenient  and  portable  limits  of  a  modera"le  sized  duod>>cimo,  and  at  the  very  low  price 
affixed,  It  is  offered  as  one  of  the  cheapest  volumes  before  the  profession. 

Dr  Fownes' excellent  work  has  been  universally 
recognized  everywhere  in  liis  own  and  this  founlry, 
as  the  best  elementary  treatise  on  chemiscry  in  the 


English  tongue,  and  is  very  gerierallv  adopted,  we 
believe,  as  the  standard  text  hook  in  alli  ur  colleges, 
both  literiiry  and  scientific. — Charleston  M.ed  Journ. 
and  Review,  Sept.  1859. 

A  standard  manual,  which  has  long  enjoyed  the 
reputation  of  embodying  much  knowledge  in  a  small 
space.  The  author  liasachieved  the  difficult  task  of 
condensation  with  masterly  tact.  His  book  is  con- 
cise without  being  dry,  and  brief  witliout  being  too 
dogmatical  or  general . —  Virginia  Med.  and  Surgical 
Journal. 


The  work  of  Dr.  Fownes  has  long  been  before 
the  public,  and  its  merits  have  been  fully  appreci- 
ated as  the  best  text-book  on  chemistry  now  io 
existence.  We  do  not,  of  course,  place  it  in  a  rank 
superior  to  the  works  of  Brunde,  Graham,  Turner, 
Gregory,  or  Gmelin,  but  we  say  that,  as  a  work 
for  students,  it  is  preferable  to  any  of  them. — Lon- 
don Journal  of  Medicine. 

A  work  well  adapted  to  the  wants  of  the  student 
It  is  an  excellent  exposition  of  the  chief  doctrines 
and  facts  of  modern  chemistry.  The  size  of  the  work, 
and  still  more  the  condensed  yet  perspicuous  style 
in  which  it  is  written,  absolve  it  from  the  charges 
very  properly  urged  against  most  manuals  termed 
popular. — Edinburgh  Journal  of  Medical  Scienct. 


fiske   fund  prize  essays  —the  ef- 
fp:cts  of  climate  on  tuberculous 

DISEASE.  By  Edwin  Lee,  M.R.C  S.London, 
and  THK  INFLUKNCK  oF  PREGNANCY  ON 
THE  DEVELOi'AIENT  OF  TUBERCLES     By 


Edward  Wareisn,  M.  D  ,  of  Edenton,  N.  C.  To- 
gether in  one  neat  8vo  volume,  extra  cloth.  S^I  00. 
FRICK  OxN  RENAL  AFFKCTIONS;  their  Diag- 
nosis and  Pathology.  With  illustrations.  One 
volume,  royal  l'2mo.,  extra  cloth.    75  cents. 


FERGUSSON   (WILLIAM),  F.  R.  S., 

Professor  of  Surgery  in  Kine's  Collesre,  London,  &c. 

A  SYSTEM  OF  PRACTICAL  SURGERY.     Fourth  American,  from  the  third 

and  enlarged  London  edition.    In  one  large  and  beautifully  printed  octavo  volume,  of  about  700 
pages,  with  393  handsome  illustrations,  leather.     $3  00. 


GRAHAM  (THOMAS),  F.  R.  S. 
THE  ELEMENTS   OF   INORGANIC   CHEMISTRY,  including  the  Applica- 

tions  of  the  Science  in  the  Arts.   New  and  much  enlarged  edition,  by  He.\ry  Watts  and  Robert 
Bridges,  M.  D.     Complete  in  one  large  and  handsome  octavo  volume,  of  over  800  very  large 
pages,  with  two  hundred  and  thirty-two  wood-cuts,  extra  cloth.     $4  00. 
,^*^  Part  II.,  completing  the  work  from  p.  431  to  end,  with  Index,  Title  Matter,  &c.,  may  be 

had  separate,  cloth  backs  and  paper  sides.    Price  $2  50. 

From  Prof.  E.  N.  Horsford,  Harvard  College.       \  afford  to  be  without  this  edition  of  Prof.  Graham's 
It  has,  in  its  earlier  and  less  perfect  editions,  been  j  Elements.— SJi/i»ian'*  Journal,  March,  18.53. 

familiar  to  me,  and  the  excellence  of  its  plan  and  i     p^g^^  p^„f  Woicott  Gihbs,  N.  Y.  Free  Academy. 

the  clearness  and  eompletentss  of  its  discussions,        _,,  ,    .  ,     ■     l,  •       ,,  .         j 

have  long  been  my  admiration.  .    The  vvork  is  an  admirable  one  in  all  respects, and 

I  its  republicatKm  here  cannot  fill  to  exert  a  positive 
No  reader  of  English  works  on  this  science  can  .  influence  upon  the  progress  of  science  in  this  country. 


GRIFFITH  (ROBERT  E.),  M.  D.,  &.c. 
A  UNIVERSAL  FORMULARY,  containing  the  methods  of  Preparing  and  Ad- 

ministering  Officinal  and  other  Medicines.  The  whole  adapted  to  Physicians  and  Pharmaceu. 
lists.  Second  Edition,  thoroughly  revised,  with  numerous  additions,  by  Robert  P.  Thomas, 
M.  D.,  Professor  of  Materia  Medica  in  the  Philadelphia  College  of  Pharmacy.  In  one  large  and 
handsome  octavo  volume,  extra  cloth,  of  650  pages,  double  columns.    $3  00;  or  in  sheep,  $3  25. 


It  was  a  work  requiring  much  perseverance,  and 
when  published  was  looked  upon  as  by  far  the  best 
work  of  its  kind  that  had  issued  from  the  American 
press.  Prof  Thomas  has  certainly  "improved."  as 
well  as  added  lolhis  Formulary,  and  has  rendered  il 
additionally  deserving  of  llie  coiifidence  of  pharma- 
ceutists and  physicians.— j4ot.  Journal  of  Pharmacy. 

We  are  happy  to  announce  a  new  and  improved 
edition  of  this,  one  of  the  most  valuable  and  useful 
works  that  have  emanated  from  an  American  pen. 
It  would  do  credit  to  any  country,  and  will  be  found 
of  daily  usefulness  to  practitioners  of  medicine;  il  is 
better  adapted  10  their  purposes  than  the  dispensaio 
ries. — Southern  Med.  and  Surg.  Journal. 

It  is  one  of  the  most  useful  books  a  country  practi- 
tioner can  possibly  have. — Medical  Chronicle. 


This  is  a  work  of  six  hundred  and  fifty  one  pageu, 
■mhracing  all  on  tlie  sulijeci  of  preparine  and  admi- 
lusiering  medicines  that  can  be  desired  by  the  phygi- 
''Jan  and  pharmaceutist. —  Western  Lancet. 

The  amouniof  useful, every-day  matter. for  a  prac 
licing  physician,  is  really  immense.— Bo.«/o»i  Med. 
and  Surg.  Journal. 

This  edition  has  been  greatly  improved  by  the  re- 
vision and  ample  adilitions  of  Dr  Tlionri*  and  is 
now,  we  believe,  one  of  the  most  po'iijileit-  works 
of  its  kind  ill  any  language.  Tht  addllioii''  amount 
to  about  seventy  pages,  and  no  effori  ha-  ln-rn  spared 
to  include  in  them  all  the  rcenl  improveiiifiiis  K 
work  of  this  kind  appears  lo  us  indispeii-able  lo  ihe 
physician,  and  there  is  none  .ve  can  more  cordially 
recommend.— iV.  Y.  Journal  of  Medicine. 


16 


BLANCHARD    &    LEA'S    MEDICAL 


GROSS  (SAMUEL  D.),   M.  D., 

Professor  of  Surgery  in  the  Jefferson  Medical  College  of  Philadelphia,  &c. 

Just  Issued. 

A  SYSTEM  OF  SURGERY :  Pathological,  Diagnostic,  Therapeutic,  and  Opera- 

xive.     Illustrated  by  Nine  Hcnpred  and  Thirtv-six  Engravings.     In  two  large  and  beautifully 

printed  octavo  volumes,  of  nearly  tv/enty-four  liundred  pages;  strongly  bound  in  leather,  with 

raised  bands.     Price  $12. 

From  the  Author's  Preface. 

"  Th,e  object  of  this  work  is  to  furnish  a  systematic  and  comprehensive-treatise  on  the  science  and 
practice  of  surgery,  considered  in  the  broadest  sense;  one  that  shall  serve  the  practitioner  as  a 
faithful  and  available  guide  in  his  daily  routine  of  duty.  .  .  .  My  aim  has  been  to  embrace  the 
whole  domain  of  surgery,  and  to  allot  to  every  subject  its  legitimate  claim  to  notice  in  the  great 
family  of  external  diseases  and  accidents.  How  far  this  object  has  been  accomplished,  it  is  not  for 
me  to  determine.  It  may  safely  be  afi'irmed,  however,  that  there  is  no  topic,  properly  appertaining 
to  surgery,  that  will  not  be  found  to  be  discussed,  to  a  greater  or  less  extent,  in  these  volumes." 

Has  Dr.  Gross  satisfactorily  fulfilled  this  object?  I  style  of  publication,  that  we  can  honestly  recom- 


A  careful  perusal  of  his  volumes  enables  us  to  give 
an  answer  in  the  affirtiia  tive.  Not  only  has  he  given 
to  the  reader  an  elaborate  and  well-wriiten  account 
of  his  o^n  vast  experience,  but  he  has  not  failed  to 
embody  in  his  pages  the  opinions  and  practice  of 
surgeons  in  this  and  other  countries  of  Europe.  The 
result  has  been  a  work  of  such  completeness,  that  it 
has  no  superior  m  the  systematic  treatises  on  sur- 
gery which  have  emanated  from  English  or  Conti- 
nental authors.  It  has  been  justly  objected  that 
these  have  been  far  from  cotnplele  in  many  essential 
particulars,  many  of  them  having  been  deficient  in 
some  of  the  most  important  points  whi-jh  should 
characterize  such  works  Some  of  them  have  been 
elaborate — too  elaborate— wiih  respect  to  certain 
diseases,  while  they  have  merely  glanced  at,  or 
given  an  unsatistactory  account  of,  others  equally 
important  to  the  surgeon.  Dr.  Gross  has  avoided 
this  error,  and  has  produced  the  most  complete  work 
that  has  yet  issued  from  the  press  on  the  science  and 
practice  of  surgery.  It  is  not,  strictly  speaking,  a 
Dicth nary  of  Surgery,  but  it  gives  to  the  reader  all 
the  information  that  he  may  require  forhis  treatinent 
i»f  surgical  diseases.     Having  said  so  much,  it  might 


mend  it  as  the  best  work  of  the  kind  to  be  taken 
home  by  the  young  practitioner. — Am.  Med.  Journ. 
The  treatise  of  Prof.  Gross  is  not,  therefore,  a 
mere  text-book  for  undergraduates,  but  a  systema- 
tic record  of  more  than  thirty  years'  experience, 
reading,  and  reflection  by  a  man  of  observation, 
sound  judgment,  and  lare  practical  fact,  and  as  sucli 
deserves  to  tahe  rank  w^ith  the  renowned  produc- 
tions of  a  similar  character,  by  Vidal  and  Boyer,  of 
France,  or  those  of  Chelius,  Blasius,  and  Langen- 
beck,  of  Germany.  Hence,  we  do  not  hesitate  to 
express  the  opinion  that  it  will  speedily  take  the 
same  elevated  position  in  regard  to  surgery  that  lias 
been  given  by  common  consent  to  the  masterly  work 
of  Pertira  in  Materia  Medi  -a,  or  to  Toud  and  Bow- 
man in  Physiology. — A'.  O.  Med.  and  Surg.  Journal. 

At  present,  however,  our  object  is  not  to  review 
the  work  (this  we  purpose  doing  hereaiter),  but 
simply  to  announce  its  appearance,  that  in  the 
meantime  our  readers  may  procure  and  examine  it 
for  themselves.  But  even  this  much  we  cannot  do 
without  expressing  the  opinion  that,  in  putting  forth 
these  two  volumes,  Dr.  Gross  has  reared  for  hirn- 


Of  Dr.  Gross's  treatise  on  Surgery  we  can  say 
no  more  than  that  it  is  the  most  elaborate  and  com- 
plete work  on  this  branch  of  the  I  eating  art  which 
has  ever  been  published  in  any  country.  A  sys- 
tematic work,  it  admits  of  no  analvtical  review 


appear  superfluous  to  add  another  w  ird  ;  but  it  is  self  a  lasting  monument  to  his  skill  as  a  surgeon, 
only  due  to  Dr.  Grois  to  state  that  he  has  embraced  «n<l  '"  "'^  industry  and  learning  as  an  author.— S<. 
the  opportunity  of  transferring  to  his  pages  a  vast  |  l-oui$  Med.  and  Surg.  Journal. 
number  o(  engravings  from  English  and  other  au-  l  With  pleasure  we  record  the  completion  of  this 
ttiors,  illustrative  oi  the  pathology  and  treatment  of  long-anticiptted  work.  The  reputation  which  the 
surgical  diseases.  To  these  are  added  several  hun-  |  author  has  for  many  years  sustained,  both  as  a  sur- 
dred  original  wood-cuts.  The  work  altogether  com-  j  geon  and  as  a  writer,  had  prepared  us  to  expect  a 
mentis  itself  to  the  attention  of  British  surgeons,  i  treatise  of  great  excellence  and  originality ;  but  we 
from  whom  it  cannot  fail  to  meet  with  extensive  ctmfess  we  were  by  no  means  prepared  lor  the  work 
patronage. — London  Lancet,  Sept.  1,  18C0.  which  is  before  us — the  most  complete  treatise  upon 

surgery  ever  published,  either  in  this  or  any  othtr 

country,  and  we  might,  perhaps,  safely  say,  the 

I  most  original.     Thert  is  no  subject  belonging  pro- 

I  pcrly  to  surgery  which  has  not  received  from  the 

j  author  a  due  share  of  attention.     Dr.  Grof  s  has  sup- 

,,,,,,.!  plied  a  want  in  surgical  literature  which  has  long 

but,  did^  our  spacj  permit,  we  sh.-uld^  gladly  gye  .  ,,^g„  f^n  ^y  practitioners;  he  has  furnished  us  with 

"""""" "" "■"  ~"  ts 

the 
-,     ,  ,    ^  .,   ,    „   ■  I  ...... ^  ,....^.., ,  „„  „„rgeons,  we  are  most  sincerely 

Quarterly  Journal  of  Med.  Science.  thankful  to  him  for  his  extraord  nary  labors  in  our 

The  work  is  so  superior  to  its  predecessors  in     behalf. — N.  Y.  Monthly  Review  and  Buffalo  Med. 
matter  and  extent,  as  well  as  in  illustrations  and     Journal. 

BY  THE  SAME  AUTHOR. 

ELEMENTS  OF  PATHOLOGICAL  ANATOMY.     Third  edition,  thoroughly 

revised  and  greatly  improved.     In  one  large  and  very  handsome  octavo  volume,  with  ab>iut  three 
hundred  and  fifty  beautiful  illustrations,  of  which  a  large  number  are  from   original  drawings. 
Price  in  extra  cloth,  H  75;  leather,  raised  bands,  %")  25.     {Lately  Puhlished.) 
The  very  rapid  advances  in  the  Science  of  Pathological  Anatomy  during  the  last  few  years  have 
rendered  essential  a  thorough  modification  of  this  work,  with  a  view  of  making  it  a  correct  expo- 
nent of  the  present  state  of  the  subject.     The  very  careful  manner  in  which  this  task  has  been 
executed,  and  the  amount  of  alteration  which  it  has  undergone,  have  enabled  the  author  to  say  that 
"  with  the  many  changes  and  improvements  now  introduced,  the  work  may  be  regarded  almost  as 
a  new  treatise,"  while  the  efforts  of  the  author  have  been  seconded  as  regards  the  mechanical 
execution  of  the  volume,  rendering  it  one  of  the  handsomest  productions  of  the  American  press. 
We  most  sincerely  congratulate  the  author  on  the        We  have  been  favorably  impressed  with  the  gene- 


^..v,  v....  .....   c|,..v,>,  ,........»,  ..V,  „.......«  p. ,....,  g..^  .  ueen  lelt  by  practitioners;  ne  lias  turnished  us  witi 

some  extracts  from  it,  loenable  our  readers  to  judge  ■  ^  complete  practical  treatise  upon  surgery  in  all  it 
of  the  classical  siyle  of  the  author,  and  the  exhaust-  !  departments  As  Aneric  ins,  we  are  proud  of  th 
ing  way  in  which  eacli  subject  is  treated.-DMfriin    achievement;  as  surgeons,  we  are  most  sincere!- 


successful  manner  in  which  he  has  accomplished  his 
proposed  object.  His  book  is  most  admirably  cal 
culated  to  fill  up  a  blank  which  has  long  been  felt  to 


ral  manner  in  which  Dr.  Gross  has  executed  his  task 
of  alTordinK  a  comprehensive  digest  of  the  present 
state  of  the  literature  of  Pathological  Anatomy,  and 


exist  in  this  department  of  medical  literature,  and  j  have  much  pleasure  in  recommending  his  work  to 
as  such  must  become  very  widely  circulated  amongst  I  our  readers,  as  we  believe  one  well  deserving  of 
all  classes  of  the  profession.  —  Dublin  QuarJer/y  j  diliL-ent  perusal  and  careful  study. — Montreal  Med. 
Journ.  of  Med.  Science,  Nov.  1857.  I  Chron.,  Sept.  1857. 

BY  THE  SAME  AUTHOR. 

A  PRACTICAL  TREATISE  ON  FOREIGN  BODIES  IN  THE  AIR-PAS- 

SAGES.    In  one  handsome  octavo  volume,  extra  cloth,  with  illustrations,    pp.  468.    $2  75. 


AND    SCIENTIFIC   PU  BL.TC  ATIONS. 


17 


GROSS  (SAMUEL    D.),    M.  D.. 
Professor  of  Surgery  in  the  Jefferson  Medical  College  of  Philadelphia,  &c. 

A   PRACTICAL    TREATISE   ON    THE    DISEASES,    INJURIES,  AND 

MALFORMATIONS  OF  THE  URINARY  BLADDER,  THE  PROSTATE  GLAND,  AND 
THE  URETHRA.     Second  Edition,  revised  and  muoh  enlarged,  wilh  one  hundred  and  eighty- 
four  illustrations.     In  one  large  and  very  handsome  octavo  volume,  of  over  nine  hundred  pages. 
In  leather,  raised  bands,  $5  2-5 ;  extra  cloth,  $4  75. 
Philos'iphical  in  'ts  desig^n,  methodical  in  its  ar- 

rausement,  ample  and  sound  in  its  practical  details, 

it  may  in  truth  be  saiO  to  leave  scarcely  anything  to 

be  desired  on  so  important  a  subject. — Boston  Med. 

and  Snrg  Journal. 

Whoever  will  peruse  the  vast  amount  of  valuable 
practical  information  it  contains,  will,  we  think, 


agree  with  us,  that  there  is  no  work  in  the  English 
language  which  can  make  any  just  pretensions  to 
be  its  equal. —  N.  Y.  .Journal  of  Medicine. 

A  volume  replete  with  truths  and  principles  of  the 
atmost  value  in  the  investigation  of  these  diseases.— 
American  MedicalJournal . 


GRAY  (HENRY),    F.  R.  S., 

Lecturer  on  Anatomy  at  St.  George's  Hospital,  London,  &<». 

ANATOMY,  DESCRIPTIVE  AND   SURGICAL.      The  Drawings  by  H.  V. 

Carter,  M.  D.,  late  Demonstrator  on  Anatomy  at  St.  George's  Hospital ;  the  Dissections  jointly 
by  the  Author  and  Dr.  Carter.  In  one  magnificent  imperial  octavo  volume,  of  nearly  SOb 
pages,  with  363  large  and  elaborate  engravings  on  wood.  Price  in  extra  cloth,  $6  25;  leather 
raised  bands,  $7  00.    {Just  Issued.) 

The  author  has  endeavored  m  this  work  to  cover  a  more  extended  range  of  subjects  than  is 
customary  in  the  ordinary  text-books,  by  giving  not  only  the  details  necessary  for  the  student,  but 
also  'he  application  of  those  details  in  the  practice  of  medicine  and  surgery,  thus  rendering  it  both 
a  guide  for  the  learner,  and  an  admirable  work  of  reti^rence  tor  the  active  practitioner.  The 
engravings  form  a  special  feature  in  the  work,  many  of  them  being  the  size  of  nature,  nearly  all 
original,  and  havingthe  names  ot  the  various  parts  printed  on  the  body  of  the  cut,  in  place  of  figures 
of  reterence  with  descriptions  at  the  foot.  They  thus  form  a  complete  and  splendid  series,  which 
will  greatly  assist  the  student  i.i  obtaining  a  clear  idea  of  Anatomy,  and  will  also  serve  to  refresh 
the  memory  of  those  who  may  hiid  in  the  exigencies  of  practice  the  necessity  of  recalling  the  details 
of  the  dissecting  room  ;  while  combining,  as  it  does,  a  complete  Atlas  of  Anatomy,  with  a  thorough 
treatise  on  systematic,  descriptive,  and  applied  Anatomy,  the  work  will  be  found  of  essential  use 
to  all  physicians  who  receive  students  in  their  othces,  relieving  both  preceptor  and  pupil  of  much 
labor  in  laying  the  groundwork  of  a  thorough  medical  education. 


The  work  before  us  is  one  entitled  to  the  highest 
praise,  f  nd  we  accordingly  welcome  it  as  a  valu- 
able addition  to  medical  literature.  Intermediate 
in  fulness  of  detail  between  the  treatises  of  S  lar 
pey  and  of  Wilson,  its  characteristic  merit  lies  in 
the  number  and  excellence  of  the  engravings  it 
contains.  Most  of  these  are  original,  of  much 
larger  than  ordinary  size,  and  admiral)  y  executed. 
The  various  parts  are  also  lettered  after  the  plan 
adopted  in  Holden's  Osteology.  It  would  be  aiffi- 
cnlt  to  over-estimate  the  advantages  olfertd  by  this 
mode  of  pictorial  illusiration.  Bones,  ligaments, 
muscles,  bloodvessels,  and  nerves  are  each  in  turn 
fiffured,  and  marked  with  their  appropriate  names  ; 
thus  enabling  the  student  to  C(  mprehend,  at  a  glance, 
what  would  otnerwise  often  be  ignored,  or  at  any 
rate,  acquired  only  by  prolonged  and  irksome  ap- 
plicatiim.  In  conclusion,  we  heartily  commend  the 
work  of  Mr.  Gray  to  the  attention  of  the  meuical 
profession,  feeling  certain  that  it  should  be  regarded 
as  one  of  the  most  valuable  contributions  ever  made 
to  educational  literature. — N.  Y.  Monthly  Review. 
Dec.  1859. 

In  ^his  view,  we  regard  the  work  of  Mr.  Gray  as 
far  belter  adapted  to  the  wants  of  the  profession, 
and  especially  of  the  student,  than  any  treatise  on 
anatomy  yet  published  in  this  country.  It  is  destined. 
we  believe,  to  supersede  \\\  others,  both  as  a  manual 
of  dissections,  and  a  standard  of  reference  to  the 
student  of  general  or  relative  anatomy.  —  N.  Y. 
Journal  of  Medicine,  Nov.  18.59. 

This  is  by  all  comparison  the  most  excellent  work 
on  Anatomy  extant.  It  is  just  the  thing  that  has 
be<n  long  desired  by  the  professi<m.  With  such  a 
guide  as  this,  the  student  of  anatomy,  the  practi- 
tioner of  medicine,  and  the  surgical  devotee  have 
all  a  newer,  clearer,  and  more  radiant  light  thrown 
np(m  the  intricacies  and  mysteries  of  this  wonder- 
ful science,  and  are  thus  enabled  to  accomplish  re- 
sults which  hitherto  seemed  possible  only  to  the 
specialist.  The  plates,  which  are  copied  irom  re- 
cent dissections,  are  so  well  executed,  that  the  most 
superficial  observer  cannot  fail  to  perceive  the  posi- 
tions, relations,  and  distinctive  features  of  the  vari- 
ous parts,  and  to  take  in  more  of  anatomy  at  a  glance, 
than  by  many  long  hours  of  diligent  study  over  the 
most  erudite  treatise,  or,  perhaps,  at  the  dissecting 
table  itself. — Med.  Journ.  of  N.  Carolina,  Oct.  1859. 

For  this  truly  admirtible  work  the  profession  is 
indebted  to  the  distinguished  author  of  "  Gray  on 
the  Spleen."    The  vacancy  it  fills  has  been  long  felt 


to  exist  in  this  eoun'ry.  Mr.  Gray  writes  through- 
out with  both  branches  of  his  subject  in  view.  His 
description  of  each  particular  part  is  followed  by  a 
notice  of  its  relations  to  tie  parts  with  which  it  is 
connected,  and  this,  too,  sufficiently  ample  for  all 
the  purposes  of  the  operative  surgeon.  After  de- 
scribing the  bones  and  muscles,  he  gives  a  concise 
statement  of  the  fractures  to  which  the  hone§  of 
the  extremities  are  most  liable,  together  with  the 
amount  and  ciirection  of  the  displacement  tj  which 
the  fragments  are  subjected  by  muscular  actiim. 
The  section  on  arteries  is  remarkably  full  and  ac- 
curate. Not  only  is  the  surgical  anatomv  given  to 
eviry  important  vessel,  with  directiims  for  its  liga- 
tion, but  at  tlie  end  of  the  description  of  each  arte- 
rial trunk  vve  have  a  useful  summary  of  the  irregu- 
larities which  may  occur  in  its  origin,  course,  and 
termination. — N.  A.  Med.  Ckir.  Review,  Mar.  1659. 

Mr.  Gray's  book,  in  excellency  of  arrangement 
and  comnleteness  of  execution,  exceeds  any  work 
on  anatomy  hitherto  published  in  the  English  lan- 
guage, affording  a  complete  view  of  the  structure  of 
the  human  bodv,  with  especial  reference  to  practical 
surgery.  Thus  the  volume  constitutes  a  perfect  book 
of  reference  for  the  practitioner,  demanding  a  place 
in  even  the  most  limited  library  of  the  physician  or 
surgeon,  and  a  work  of  necessity  for  the  student  to 
fix  in  his  mind  what  he  has  learned  by  the  dissecting 
knife  from  the  book  of  nature. — Tke  Duhlin  Quar- 
terly Journal  of  Med.  Sciences,  Nov.  lb'58. 

In  our  judgment,  the  mode  of  illustration  adopted 
in  the  present  volume  cannot  but  present  many  ad- 
vantages to  the  studentof  anatomy.  To  the  zealous 
disciple  of  Vesalius,  earnestly  desirous  of  real  im- 
provement, the  book  will  certainly  be  of  immense 
value ;  but,  at  the  same  time,  we  must  also  confess 
that  to  those  simplv  desirous  of  "cramming"  it 
will  be  an  undoubted  podsend.  The  peculiar  value 
of  Mr.  Gray's  mode  of  illustration  is  nowhere  more 
markedly  evident  than  in  the  chapter  on  osteology, 
!ind  especially  in  those  portions  which  treat  of  the 
bones  of  the  head  and  of  Ihjir  development.  The 
study  of  these  parts  is  thus  made  one  of  comparative 
CHse,  if  not  of  positive  pleasure;  an<l  those  bugbears 
of  the  student,  the  temporal  and  sphenoid  bones,  are 
shorn  of  half  their  terrors.  It  is,  in  our  estimation, 
an  admirable  and  complete  text-book  for  the  student, 
and  a  useful  work  of  reference  for  the  practitioner; 
its  pictorial  character  forming  a  novel  element,  to 
which  we  have  already  sufficiently  alluded. — Am. 
Journ.  Med.  Sci.,  July,  1859. 


18 


BLANCHARD    &    LEA'S    MEDICAL 


GIBSON'S  INSTITUTES  AND  PRACTICE  OF 
SURGERY.  Eighth  edition,  improved  aiid  al- 
tered. With  thirty-four  plates.  In  tvvohandsome 
octavo  volumes,  contain in°r  about  1,000  pages, 
leather,  raised  bandi.     $6  50. 

GARDNER'S  MEDICAL  CHEMISTRY,  for  the 
use  of  Students  and  the  Prc-fi'ssion.  In  one  royal 
12mo.  vol.,  cloth,  pp.  ;jfl6,  with  woodcuts.     SI. 

GLUGE'S  ATLAS  OF  PATHOLOGICAL  HIS- 
TOLOGY.     Trui.slated,  with  Notes  and  Addi- 


tions, by  Joseph  Letdy,  M.  D.  In  one  volume, 
very  large  imperial  quarto,  extra  cloth,  wit  i  320 
copper-  plate  figures,  plain  and  colored,    $5  00. 

HUGHES'  INTRODUCTION  TO  THE  PRAC- 
TICE OF  AUSCULTAI'lON  AN1»  OTHER 
MODES  OF  PHYSICAL  DIAGNOSIS  IN  DIS- 
EASES OF  THE  LUNGS  AND  HEART.  Se- 
cond edition  1  vol.  royal  12mo.,  sx.  cloth,  pp. 
304.    $1  00. 


HAMILTON  (FRANK   H.),   M.  D., 

Professor  of  Surgery  in  the  Long  Island  College  Hospital. 

A  PRACTICAL  TREATISE  ON  FRACTURES  AND  DISLOCATIONS.     Tn 

one  larse  and  handsome  octavo  volume,  of  over  750  page.*,  with  289  illustrations.   $4  25.    [Now 
Ready,  January,  1S60.) 


Among  the  many  good  workers  at  surgery  of  vsrhom 
America  may  now  boast  rot  the  least  is  Frank  Ilast- 
ingii  Hamilton;  and  the  volume  before  us  is(we  say 
it  with  a  pang  of  wounded  patriotism)  the  best  and 
handiest  book  on  the  subject  in  the  Erglish  lan- 
guage. It  is  in  vain  to  attempt  a  review  of  it; 
nearly  as  vain  to  seek  for  any  sins,  either  of  com- 
mission or  omission.  We  have  seen  no  work  on 
practical  surgery  which  we  would  sooner  recom- 
mend to  our  brother  surgeons,  especially  those  of 
''  the  services,"  c  r  those  whose  practice  lies  in  dis- 
tricts where  a  man  has  necessarily  to  rely  on  his 
own  unaided  reEources.  The  practitioner  will  find 
in  It  directions  for  nearly  every  possible  accident, 
easily  found  and  compreliended  ;  and  much  pleasant 
tending  for  him  to  muse  over  in  the  after  confidera- 
tion  of  his  cases. — Edinburgh  Med.  Jovrn  Feb.  1601. 

This  is  a  valuable  contribution  to  the  surgery  of 
most  important  affections,  and  is  the  more  welcome, 
inasmuch  as  at  the  present  time  we  do  not  pDssess 
a  single  complete  treatife  on  Fractures  and  Dislo- 
cations in  the  English  language.  It  has  remained  for 
our  American  brother  to  produce  a  complete  treatise 
upon  the  subject,  and  bring  together  in  a  convenient 
form  tliose  alterations  and  improvements  that  have 
been  made  from  time  tolime  in  tlie  treatment  of  these 
affections.  One  great  and  valuable  feature  in  the 
work  before  us  is  the  fact  that  it  comprises  all  the 
improvements  introduced  into  the  practice  of  both 
Eng;lish  and  American  surgery,  and  though  far  from 
omitting  mention  of  our  continental  nei^hjiors,  the 
author  by  no  means  tncourages  the  notion— but  too 
prevalent  in  some  quarters— that  nothing  is  good 
unless  imported  from  France  or  Germany.  Tne 
latter  half  of  the  work  is  devoted  to  the  considera- 
tion of  the  various  dislocations  and  their  appropri- 
ate treatment,  and  its  merit  is  fully  equal  to  that  of 
the  preceding  portion.— 2'Ae  London  Z-oncer,May  5,  \ 
1860.  )        ^     ' 

It  is  emphatically  the  book  upon  the  subjects  of 
which  it  treats,  and  we  cannot  doubt  that  it  will 
Continue  so  to  be  for  an  indefinite  period  of  time. 
When  we  say,  however,  that  we  believe  it  will  at 
once  take  ils  place  as  the  best  book  for  consultation 
by  the  practitioner;  and  that  it  will  form  the  most 
complete,  available,  and  reliable  guide  in  emergen- 
cies of  every  nature  connected  with  its  subjects;  and 
also  that  the  student  of  surgery  may  make  it  his  text- 
book wi'h  entire  confidence,  and  with  pleasure  also, 
from  Us  agreeable  and  easy  sty  le— we  think  our  own 


opinion  may  be  gathered  as  to  its  value. —  Tioston 
Medical  and  Surgical  Journal,  March  1,  1860. 

The  work  is  concise,  judicious,  and  accurate,  and 
adapted  to  the  wants  of  the  student,  practiticner, 
and  investigator,  honorable  to  the  author  and  to  the 
profession. — Chicago  Med.  Journal,  March,  18G0. 

We  regard  this  work  as  an  honor  not  only  to  its 
author,  but  to  the  profession  of  our  country.  Were 
we  to  review  it  thoroughly,  we  could  not  convey  to 
the  mind  of  ihe  reader  more  forcibly  our  honest 
opinion  expressed  in  the  few  words — we  think  it  the 
best  book  ol  ils  kind  extant.  Every  man  interested 
in  surgery  will  80(m  have  this  work  on  his  desk. 
He  who  does  not,  will  be  the  loser. — New  Orleans 
Medical  News,  March,  l&CO. 

Now  that  it  is  before  us,  we  feel  bound  to  say  that 
much  as  was  expected  from  it,  and  onerous  as  was 
the  undertaking,  it  has  surpassed  expectation,  and 
achieved  more  than  was  pledged  in  its  behalf;  for 
its  title  does  not  express  in  full  the  richcess  of  its 
contents.  On  the  whole,  we  are  prouder  of  this 
work  than  of  any  which  lias  for  years  emanated 
from  the  American  medical  press;  its  sale  will  cer- 
tainly be  very  large  in  this  country,  and  we  antici- 
pate its  eliciting  much  attention  in  Europe. — Nash- 
ville Medical  Record,  Mar.  1860. 

Every  surgeon,  young  and  old,  should  possess 
himself  of  it,  and  give  it  a  careful  perusal,  in  doing 
which  he  will  be  richly  repaid. — St.  Louis  Med. 
and  Surg.  Journal,  March,  1860. 

Dr.  Hamilton  is  fortunate  in  having  succeeded  in 
filling  the  void,  so  long  felt,  with  what  cannot  fail 
to  be  at  once  accepted  as  a  model  monograph  in  some 
respects,  and  a  work  of  classicil  authority.  We 
sincerely  congratulate  the  profession  of  the  United 
States  on  the  appearance  of  such  a  publication  from 
one  of  their  number.  We  have  reason  to  be  proud 
of  it  as  an  original  work,  both  in  a  literary  and  s-i- 
entific  point  of  view,  and  to  esteem  it  as  a  valuable 
guide  in  a  most  difficult  and  important  branch  of 
study  and  practice.  On  every  account,  therefore, 
we  hope  that  it  may  soon  be  widely  known  abroad 
as  an  evideoce  of  genuine  progress  on  this  side  of 
the  Atlantic,  and  further,  that  it  may  be  si  ill  more 
widely  known  at  home  as  an  authoritative  teacher 
from  which  every  one  may  profitably  learn,  and  as 
aff.)rdingan  example  of  honest,  well-directed,  and 
untiring  industry  in  autliorship  which  every  surgeon 
may  eiuulate.-  Am.  Med.  Journal,  April,  1800, 


HOBLYN  (RICHARD  D.),  M.  D. 
A  DICTIONARY  OF  THE  TERMS  USED  IN  MEDICINE  AND  THE 

COLLATERAL  SCIENCES.  A  new  American  edition.  Revit^ed,  with  numerous  Additions, 
by  Isaac  Hays,  M.  D.,  editor  of  the  '<  American  Journal  of  the  iVledieal  Sciences."  In  one  large 
royal  12mo.  volume,  leather,  of  over  500  double  columned  pages.    $1  50. 

To  both  practitioner  and  student,  we  recommend  use;  embracingevery  department  of  medical  science 
this  dictionary  as  being  convenient  in  size,  accurate  i  down  to  the  very  latest  date. — Western  Lancet. 
in  definition,  and  sufficiently  full  and  complete  for  1      Hoblyn's  Dictionary  has  long  been  a  favorite  with 
ordinary  consultation.-C/iaW«<onMed.  Joum.  ^^      ^^jg  j^e  best  book  of  definitions  we  have,  and 

We  know  of  no  dictionary  better  arranged  and  i  ought  always   to  be   upon   the    student's  table. — 
adapted.  It  is  not  encumbered  with  the  obsolete  terms     Southern  Med.  and  Surg .  Journal . 
of  a  bygone  age,  but  it  contains  all  that  are  now  in  I 


HOLLAND'S    MEDICAL    NOTES    AND    RE- i 
FLECTIONS.     From  the  thiid  London  edition. 
In  ote  handsome  octavo  volume,  extra  ciolh.  ¥3. 

HORNER'S  SPECIAL  ANATOMY  AND  HIS- 


TOLOGY. Eighth  edition.  Extensively  revised 
and  iiioditied.  In  two  large  octavo  voli'.ines,  ex- 
tra cloth,  of  more  than  1000  pages,  with  over  300 
illustrations.     $6  00. 


AND    SCIENTIFIC    PUBLICATIONS. 


19 


HODGE  (HUGH    L.),   M.  D., 
Professor  of  Midwifery  and  the  Diseases  of  Women  and  Ctiildren  in  the  University  of  Pennsylvania,  &c. 

ON  DISEASES  PECULIAR  TO  WOMEN,  including  Displacements  of  the 
TJlerus.  With  original  illustrations.  In  one  beautifully  printed  octavo  volume,  of  nearly  500 
pages,  extra  cloth.     $3  25.     {Now  Ready.) 


We  will  say  at  once  that  the  work  fulfils  its  object 
capitally  well ;  and  we  will  moreover  venture  the 
asatrti(iii  that  it  will  inaugurate  an  imnroved  prac- 
tice thrnughoul  this  whole  country.  The  secrets  of 
the  author's  success  are  so  clearly  revealed  that  the 
attentive  student  cannot  fail  to  insure  a  goodly  por- 
tion of  similar  success  in  his  own  practice.  It  is  a 
credit  to  all  medical  literature;  and  we  add,  that 
the  physician  who  does  not  place  it  in  his  library, 
and  who  does  not  faithfully  con  its  pages,  will  lose 
a  vast  deal  of  knowledge  that  would  be  most  useful 
to  himself  and  beneficial  to  his  patients.  It  is  a 
prnctiral  work  nf  the  highest  order  of  merit;  and  it 
w^ill.take  rank  as  such  immefiiatelv. — Maryland  and 
Virginia  Medical  Journal,  Feb.  1861. 

This  contribution  towards  the  elucidation  of  the 
pathology  and  treatment  of  some  of  the  diseases 
peculiar  to  women,  cannot  fail  to  meet  with  a  favor- 
able reception  from  the  medical  profession.  The 
character  of  the  particular  maladies  of  which  the 
■work  before  us  treats;  their  frequency,  variety,  and 
obseuiity  ;  the  amount  of  malaise  and  even  of  actual 
suffering  by  which  they  are  invariably  attended; 
their  obstinacy,  the  difficulty  with  which  they  are 
overcome,  and  their  dispositicm  again  and  again  to 
lec'ir — these,  taken  in  connection  with  the  entire 
competency  of  the  author  to  render  a  correct  ac- 
count of  their  nature,  their  causes,  and  their  appro- 


priate management— his  ample  experience,  his  ma- 
tured judgment,  and  his  peifect  conscientiousness 

invest  this  puhlication  with  an  interest  and  value  to 
which  few  of  the  medical  treatises  of  a  recent  date 
can  lay  a  stronger,  if,  perchance,  an  equal  claim. — 
Atn.  Journ.  M^^d.  Sciences,  Jan.  1S61. 

Indeed,  although  no  part  of  the  volume  isnotemi- 
nently  rieserving'of  perusal  and  study,  we  think  that 
the  nine  cliapttrs  devoted  to  this  subject,  are  espe- 
cially so,  and  wt  know  of  no  more  valuable  mono- 
graph upon  the  symptom?,  prognosis,  and  manage- 
ment of  these  annoying  maladies  than  is  constituted 
by  this  part  of  the  woik.  We  cannot  but  regard  it 
as  one  of  the  most  original  and  m  ist  practical  worKs 
of  the  day  ;  one  which  every  accoucheur  and  physi- 
ciaa  should  most  carefully  re  id;  for  we  are  per- 
suaded that  he  will  arise  from  its  perusal  with  new 
ideas,  which  will  induct  him  into  a  more  rational 
practice  in  regard  to  many  a  suffering  femile,  who 
may  have  placed  tier  health  in  his  hunds.— British 
America7i  Journal,  Feb.  1661. 

Of  the  many  excellences  of  the  work  we  will  not 
speak  at  length.  We  advise  all  who  would  acquire 
a  knowledge  of  the  proper  management  of  the  mala- 
dies of  which  it  treats,  to  study  it  with  care.  The 
secf  nd  part  is  of  itself  a  most  valuable  contributi(m 
to  the  practice  of  our  arc. — Am.  Med.  Monthly  and 
New  York  Review.  Feb.  ISGl. 


The  illustrations,  which  are  all  original,  are  drawn  to  a  uniform  scale  of  one-half  the  natural  size. 


HABERSHON  (S.  O.),  M.  D., 

Assistant  Physician  to  and  Lecturer  on  Materia  Medica  and  Therapeutics  at  Guy's  Hospital,  &c. 

PATHOLOGICAL   AND   PRACTICAL  OBSERVATIONS  ON  DISEASES 

OF  THE  ALIMENTARY  CANAL,  (ESOPHAGUS,  STOMACH,  U^CUM,  AND  INTES- 
TINES. With  illustrations  on  wood.  In  one  handsome  octavo  volume  of  312  pages,  extra 
cloth      $1  75.     {Now  Ready.) 


JONES  (T.   WHARTON),   F.  R,  S., 

Professor  of  Ophthalmic  Medicine  and  Surgery  in  University  College,  London,  &c. 

THE  PRINCIPLES  AND  PRACTICE  OP   OPHTHALMIC    MEDICINE 

AND  SURGERY.  With  one  hundred  and  ten  illustrations.  Second  American  from  the  second 
and  revised  London  edition,  with  additions  by  Edward  Hartshokne,  M.  D.,  Surgeon  to  Wills' 
Hospital,  &c.     In  one  large,  handsome  royal  12mo.  volume,  extra  cloth,  ol  500  pages.    $1  50. 


JONES(G.   HANDFIELD),  F.R.S.,  &  EDWARD   H.   SIEVEKING,   M.D., 

Assistant  Physicians  and  Lecturers  in  St.  Mary's  Hospital,  London. 

A  MANUAL  OF  PATHOLOGICAL  ANATOMY.    First  American  Edition, 

Revised.     With  three  hundred  and  ninety-seven  handsome  wood  engravings.    In  one  large  and 
beautiful  octavo  volume  of  nearly  750  pages,  leather.     $3  75. 

As  a  concise  text-book,  containing,  in  a  condensed  |  obliged  to  glean  from  a  great  number  of  monographs' 
form,  a  complete  outline  of  what  is  known  in  the    and  the  field  was  so  extensive  that  but  few  cultivated 


domain  of  Pathological  Anatomy,  it  is  perhaps  the 
best  work  in  the  English  language.  Its  great  merit 
consists  in  its  completeness  and  brevity,  and  in  this 
respect  it  supplies  a  great  desideratum  in  our  lite- 
rature.   Heretofore  the  student  of  pathology  was 


it  with  any  desree  of  success.  As  a  simple  work 
of  reference,  therefore,  it  is  of  great  value  to  the 
student  of  pathological  anatomy,  and  should  be  in 
every  physician's  library. — Western  Lancet. 


KIRKES  (WILLIAM   SENHOUSE),   M.  D., 

Demonstrator  of  Morbid  Anatomy  at  St.  Bartholomew's  Hospital,  &c. 

A    MANUAL    OF    PHYSIOLOGY.      A  new  American,  from  the   third  and 

improved  London  edition.     With  two  hundred  illustrations.     In  one  large  and  handsome  royal 
12mo.  volume,  leather,     pp.  586.     $2  00.     (Lately  Publ is ked.) 


This  is  a  new  and  very  much  improved  edition  of 
Dr.  Kirkes'  well-known  Handbook  of  Physiology. 
It  combines  conciseness  with  completeness,  and  is, 
therefore,  admirably  adapted  for  consultation  by  the 
busy  practitioner. — Dublin  Quarterly  Journal. 

One  of  the  very  best  handbooks  of  Physiology  we 
possess — presenting  just  such  an  outline  of  the  sci- 
ence as  the  student  requires  during  his  attendance 
upon  a  course  of  lectures,  or  for  reference  whilst 
preparing  for  examination. —  Am.  Medical  Journal. 

Its  excellence  is  in  its  compactness,  its  clearness, 


and  its  carefully  cited  authorities.  It  is  the  most 
convenient  of  text-books.  These  gentlemen,  Messrs. 
Kirkes  and  Pa^et,  have  the  gift  of  telling  us  what 
we  want  to  know,  without'thinkiiig  it  necesjary 
to  tell  us  all  they  know. — Boston  Med  and  Surg. 
Journal. 

For  the  student  beginning  this  study,  and  the 
practitioner  who  has  but  leisure  to  refresh  his 
memory,  this  book  is  invaluable,  as  it  contains  all 
that  it  is  important  to  know. — Charleston  Med. 
Journal. 


20  BLANCHARD  &  LEA'S  MEDICAL 


KNAPP'S  TECHNOLOGY  ;  or,  Chemistry  applied 
to  the  Arts  and  to  Manufactures.  Edited  by  Dr. 
Ronalds,  Dr.  Richardson,  and  Prof.  W.  R. 
Johnson.  In  two  handsomf  8vo.  vols.,  withabout 
500  wood- engravings.    $6  00. 


LAYCOCK'S  LECTURES  ON  THE  PRINCI- 
PLES AND  METHODS  OF  MEDICAL  OU- 
SERVATION  AND  RESEARCH.  For  the  Use 
of  Advanced  Students  and  Junior  Pruclitumf rs. 
In  one  royal  12mo.  volume,  extra  cloth.  Price  SI. 


LALLEMAND  AND   WILSON. 
A    PRACTICAL    TREATISE    ON    THE    CAUSES,    SYMPTOMS,    AND 

TREATMENT  OF  SPERMATORRHCEA.     By  M.  Lali.e.mand.     Translated  and  edited  by 

Henry  J   McDougall.     Third  American  edition.     To  which  is  added ON  DISEASES 

OF  THE  VESICUL^  SEMINALES;  and  their  associated  organs.  With  special  reler- 
ence  to  the  Morbid  Secretions  of  the  Prostatic  and  Urethral  Mucous  Membrane.  By  Marris 
Wilson,  M.D.     In  one  neat  octavo  volume,  of  about  400  pp.,  extra  cloth.  $2  00.   (Juat  Issued.) 


LA   ROCHE  (R.),   M.  D.,  &c. 
YELLOW  FEVER,  considered  in  its  Historical,  Pathological,  Etiological,  and 

Therapeutical  Relations.  Including  a  Sketch  of  the  Disease  as  it  has  occurred  in  Philadelphia 
from  1699  to  1854,  with  an  examination  of  the  connections  between  it  and  the  fevers  known  under 
the  same  name  in  other  parts  of  temperate  as  well  as  in  tropical  regions.  In  two  large  and 
handsome  octavo  volumes  of  nearly  1500  pages,  extra  cloth.     $7  00. 

From  Professor  S.  H.  Dickson,  Charleston,  S.  C,  I  nant  and  unmanageable  disease  of  modern  times, 

September  18,  185.5.  has  for  several  years  been  prevailing  in  our  country 

A  monument  of  intelligent  and  well  applied  re-     to  a  greater  extent  than  ever  before;  that  it  is  no 

search,  almost  without  example.     It  is,  indeed,  in     longer  confined  to  either  large  or  small  cities,  but 


itself,  a  large  library,  and  is  destined  to  corrstitute 
the  special  resort  as  a  book  of  reference,  in  the 
subject  of  which  it  treats,  to  all  future  time. 

We  have  not  time  at  present,  engaged  as  we  are, 
by  da^'  and  by  night,  in  the  work  of  combating  this 
very  disease,  now  prevailing  in  our  city,  to  do  more 
than  give  this  cursory  notice  of  what  we  consider 
as  undoubtedly  the  most  able  and  erudite  medical 
publication  our  country  has  yet  produced.  But  in 
view  of  the  startling  fact,  that  this,  the  most  malig- 


penetrates  country  villages,  plantations,  and  farm- 
houses; that  it  is  treated  with  scarcely  better  suc- 
cess now  than  thirty  or  forty  years  ago;  that  there 
is  vast  mischief  done  by  ignorant  pretenders  to  know- 
ledge in  regard  to  the  disease,  and  in  view  of  the  pro- 
bability that  a  majority  of  southern  physiciiins  will 
be  called  upon  to  treat  the  disease,  we  trust  that  this 
able  and  comprehensive  treatise  will  he  very  gene- 
rally read  in  the  south. — Memphis  Med.  Hecorder. 


BY  THE  same  AUTHOR. 

PNEUMONIA ;  its  Supposed  Connection,  Pathological  and  Etiological,  with  Au- 
tumnal Fevers,  including  an  Inquiry  into  the  Existence  and  Morbid  Agency  of  Malaria.  In  one 
handsome  octavo  volume,  extra  cloth,  of  500  pages.    $3  00. 


LAWRENCE  (W.),   F.  R.  S.,  8cc. 
A  TREATISE   ON   DISEASES    OF    THE    EYE.     A    new  edition,  edited, 

with  numerous  additions,  and  243  illustrations,  by  Isaac  Hays.  M.  D.,  Surgeon  to  Will's  Hospi- 
tal, &c.  In  one  very  large  and  handsome  octavo  volume,  of  950  pages,  strongly  bound  in  leather 
with  raised  bands.     $5  00. 

LUDLOW  (J.   L.),   M.  D. 
A  MANUAL   OF    EXAMINATIONS   upon   Anatomy,   Physiology,   Surgery, 

Practice  of  Medicine,  Obstetrics,  Materia  Medica,  Chemistry,  Pharmacy,  and  Therapeutics.     To 
which  is  added  a  Medical  Formulary.     Third  edition,  thoroughly  revised  and  greatly  extended 
and  enlarged.     With  370  illustrations.     In  one  handsome  royal  12rao.  volume,  leather,  o)  816 
large  pages.     $2  50. 
We  know  of  no  better  companion  for  the  student  I  crammed  into  his  head  by  the  various  professors  to 

during  the  hours  spent  in  the  lecture  room,  or  to  re-     whom  he  is  compelled  to  listen. —  Western  Lancet, 

fresh,  at  a  glance,  his  memory  of  the  various  topics  |  May,  1857. 


LEHMANN    (C.  G.) 

PHYSIOLOGICAL  CHExMISTRY.  Translated  from  the  second  edition  by 
George  E.  Day,  M.  D.,  F.  R.  S.,  &:c.,  edited  by  R.  E.  Rogers,  M.  D.,  Profe.>^sor  of  Chemistry 
in  the  Medical  Department  of  the  University  of  Pennsylvania,  with  illustrations  selected  from 
Funke's  Atlas  of  Physiological  Chemistry,  and  an  Appendix  ol  plates.  Complete  in  two  large 
and  handsome  octavo  volumes,  extra  cloth,  containing  1200 pages,  with  nearly  two  hundred  illus- 
trations. $6  00. 
The  work  of  Lehmann  stands  unrivalled  as  the  I      The  most  important  contribution  as  yet  made  to 

most  comprehensive  book  of  reference  and  informa-  |  Physitdogical  Chemistry. — Am.  Journal  Med.  Sci- 

tion  extant  on  every  branch  of  the  subject  on  which     tnces,  Jan.  1856. 

it  treats. — Edinburgh  Journal  of  Medical  Science.  \ 

BY  THE  SAME  AUTHOR.     {Lately  Published.) 

MANUAL  OF  CHEMICAL   PHYSIOLOGY.      Translated  from  the  German, 

with  Notes  and  Additions,  by  J.  Cheston  Morris,  M.  D.,  with  an  Ir^roductory  Essay  on  Vital 
Force,  by  Professor  Samuel  Jackson,  M.  D.,  of  the  University  of  Penn.-ylvania.  With  illus- 
trations on  wood.    In  one  very  handsome  octavo  volume,  extra  cloth,  of  336  pages.    $2  25. 

FroKi  Prof.  J'adsoti's  Introductory  Essay, 
In  adopting  the  handbook  of  Dr.  Lehmann  as  a  manual  ot  Organic  Chemistry  for  the  use  of  the 
students  of  the  University,  and  in  recommending  his  original  work  of  Physiological  Chemistry 
for  their  inore  mature  studies,  the  high  value  of  his  researches,  and  the  great  weigtil  of  his  autho- 
rity in  that  important  department  of  medical  science  are  fully  recognized. 


AND    SCIENTIFIC    PUBLICATIONS. 


21 


LYONS  (ROBERT   D.),    K.  C.  C, 

Late  Pathologist  in-chief  to  the  British  Army  in  the  Crimea,  &c. 

A  TREATISE  ON  FEVER;  or.  selections  from  a  course  of  Lectures  on  Fever. 
Being  part  of  a  course  of  Theory  and  Practice  of  Medicine.  la  one  neat  octavo  volume,  of  3(32 
pages,  extra  cloth;  $2  00.     {^Now  Ready.) 

From  the  Author'' s  Preface. 

"lam  induced  to  publish  this  work  on  Fever  with  a  view  to  bring  within  the  reach  of  the 
student  and  junior  practitioner,  in  a  convenient  form,  the  more  recent  results  of  inquiries  into  the 
Pathology  and  Therapeutics  of  this  formidable  class  of  di>eases. 

"  Tlie  works  of  the  great  writers  on  Fever  are  so  numerous,  and  in  the  present  day  are  scattered 
in  so  many  languages,  that  they  are  diHicult  of  access,  not  only  to  students  but  also  to  practitioners. 
I  shall  deem  myself  fortunate  if  I  can  in  any  measure  supply  the  want  which  is  felt  in  this  respect. 


We  have  great  pleasure  in  recommending  Dr. 
Lyons'  work  on  ¥tvt.r  to  the  attention  of  the  pro- 
fession. It  is  a  work  whieh  cannot  fail  to  enhance 
the  author's  previous  well-earned  reputation,  as  a 
diligent,  careful,  and  accurate  observer. — British. 
Mf.ri.  .Tournal,  March  2,  1861. 

Taken  as  a  whole  we  can  recommend  it  in  the 
highest  terms  as  well  worthy  the  careful  perusal 
and  study  of  every  student  and  practitioner  of  medi- 


cine. We  consider  the  work  a  most  valuable  addi- 
tion to  medical  literature,  and  one  destined  to  wield 
no  little  influence  over  the  mini  of  the  profession. — 
Med  and  Swf.  Report- r,  May  4,  1861. 

This  is  an  admirable  work  upon  the  most  remark- 
able and  most  important  class  of  diseases  to  which 
mankind  are  lialjle. — Mtd.  Journ.  of  N.  Carolina, 
Mdy,  1861. 


MEIGS  (CHARLES  D.),  M.D., 

Professor  of  Obstetrics,  &c.  in  the  Jefferson  Medical  College,  Philadelphia. 

OBSTETRICS :   THE   SCIENCE   AND   THE   ART.     Third  edition,  revised 

and  improved.    With  one  hundred  and  twenty-nine  illustrations.  In  one  beautifully  printed  octavo 
volume,  leather,  of  seven  hundred  and  fifty-two  large  pages.     $3  75. 

The  best  American  work  on  Midwifery  that  is 
accessible  to  the  student  and  practitioner — JV.  W. 
Med.  and  Surg.  Journal,  Jan.  1S57. 

This  is  a  standard  work  by  a  great  American  Ob- 
stetrician. It  is  the  third  and  last  edition,  and,  in 
the  larguage  of  the  preface,  the  author  has  "br<mght 
the  subject  up  to  the  latest  dates  of  real  improve- 
ment in  our  art  and  Science." — Nashville  Journ.  of 
Med.  and  Surg.,  May,  1857. 


Though  the  work  has  received  only  five  pages  of 
enlargement,  its  chapters  throughout  wear  the  im- 
press of  careful  revision.  Expunging  and  rewriting, 
remodelling  its  sentences,  with  occasional  new  ma- 
terial, all  evince  a  lively  desire  that  it  shall  deserve 
to  be  regarded  as  improved  in  manner  as  well  as 
matter.  In  the  matter,  every  stroke  of  the  pen  has 
increased  the  value  of  the  book,  both  in  expungings 
and  additions  — Western  Lancet,  Jan.  1857. 


BY   THE  SAME  AUTHOR.      (JliSt  Issued.) 

WOMAN:  HER  DISEASES  AND  THEIR  REMEDIES.  A  Series  of  Lec- 
tures to  his  Class.  Fourth  and  Improved  edition.  In  one  large  and  beautifully  printed  octava 
volume,  leather,  of  over  700  pages. 


$3  60, 

In  other  respects,  in  our  estimation,  too  much  can- 
not be  said  in  praise  of  this  work.  Ic  a'jounds  with 
beautiful  passages,  and  for  conciseness,  for  origin- 
ality, and  for  all  that  is  commendable  in  a  work  on 
the  diseases  of  females,  it  is  not  excelled,  and  pro- 
b  ibly  not  equalled  in  the  English  language.  On  the 
whole,  we  know  of  no  worK  on  the  diseases  of  wo- 
men which  we  can  so  cordially  commend  to  the 
student  hnd  practitioner  as  the  one  before  us. — Ohio 
Med.  and  Sttrg.  Journal. 

The  body  of  the  book  is  worthy  of  attentive  con- 
sideration, and  is  evidently  the  production  of  a 
clever,  thoughtful,  and  sagacious  physician.  Dr. 
Meigs's  letters  on  the  diseases  of  the  external  or- 
gans, contain  many  interesting  and  rare  cases,  and 
many  instructive  observations.  We  take  our  leave 
of  Dr.  Meigs,  w^ith  a  high  ojunion  of  his  talents  and 
originality.— r/ie  British  and  Foreign  Medico-Chi- 
rurgical  Review. 

Every  chapter  is  replete  with  practical  instruc- 
tion, and  bears  the  ir.ipress  of  being  the  coniijosition 
of  an  acute  and  experienced  mind.  There  is  a  terse- 
ness, and  at  the  same  time  an  accuracy  in  his  de- 
scription o(  symptoms,  and  in  the  rules  for  diagnosis, 


which  cannot  fail  to  recommend  the  volume  to  the 
attention  of  the  reader. — Ranking^s  Abstract. 

It  contains  a  vast  amount  of  practical  knowledge. 
tiy  one  who  has  accurately  observed  and  retained 
the  experience  of  many  years. — Dub'.in  Quarterly 
Journal. 

Full  of  important  matter,  conveyed  in  a  ready  and 
agreeaole  manner.— Sr Lewis  Med.  and  Surg.  Jour. 

There  is  an  off-hand  fervor,  a  glow,  and  a  warm- 
heartedness infecting;  the  effirt  of  Dr.  Meigs,  which 
is  entirely  captivating,  and  which  absolutely  hur- 
ries the  reader  through  from  beginning  to  end.  Be- 
sides, the  book  teems  with  solid  instruction,  and 
it  shows  the  very  highest  evidence  of  ability,  viz., 
the  clearness  with  which  the  information  is  pre- 
3ented.  We  know  of  no  better  test  of  one's  under- 
standing a  subject  than  the  evidence  of  the  power 
of  lucidly  explaining  it.  The  most  elementary,  as 
well  as  the  obscurest  subjects,  under  the  pencil  of 
Prof.  Meigs,  are  isolated  and  made  to  stand  out  in 
such  bold  relief,  as  to  produce  distinct  impressions 
upim  the  mind  and  memory  of  the  reader.  —  Th* 
Charleston  Med.  Journal. 


BY  THE  SAME  AtTTHOR. 

ON    THE    NATURE,    SIGNS,    AND    TREATMENT    OF    CHILDBED 

FEVER.     In   a  Series  of  Letters  addressed  to  the  Students  of  his  Class.    In  one  handsome 
octavo  volume,  extra  cloth,  ol  365  pages.     $2  50. 

lectable  book.  *    *    *   This  treatise  upon  child- 


The  instructive  and  interesting  author  (if  this 
work,  whose  previous  labors  have  placed  his  coun- 
trymen under  deep  and  abiding  obligations,  again 
challenges  their  admiration  in  the  fresh  and  vigor- 
ous, attractive  and  racy  pages  before  us.   It  is  a  de- 


bed  fevers  will  have  an  extensive  sale,  being  des- 
tined, as  it  deserves,  to  find  a  place  in  the  library 
of  every  practitioner  who  scorns  to  lag  in  the  rear. — 
Nashville  Journal  of  Mediiini  and  Surgery. 


BY   THE  SAME   AUTHOR;   WITH  COLORED  PLATES. 


A  TREATISE  ON  ACUTE  AND  CHRONIC  DISEASES  OF  THE  NECK 

OF  THE  UTERUS.     With  numerous  plates,  drawn  and  colored  from  nature  in  the  highest 
style  ol  art.    In  one  handsome  octavo  volume,  extra  cloth.    $4  50. 


22 


BLANCHARD    &    LEA'S    MEDICAL 


MACLISE   (JOSEPH),    SURGEON. 
SURGICAL  ANATOMY.     Forming   one  volume,   very  large  imperial  quarto. 

With  f^ixty-eight  large  and  splendid  Plates,  drawn  in  the  best  style  and  beautifully  colored.    Con- 
taining one  hundred  and  ninety  Figures,  many  of  them  the  size  of  life.     Together  with  copious 
and  explanatory  letter-press.     Strongly  and  handsomely  bound  in  extra  cloth,  being  one  of  the 
cheapest  and  best  executed  Surgical  works  as  yet  issued  in  this  country.    $11  00. 
*^*  The  size  of  this  work  prevents  its  transmission  through  the  post-orfice  as  a  whole,  but  those 

who  desire  to  have  copies  forwarded  by  mail,  can  receive  them  in  five  parts,  done  up  in  stout 

wrappers.     Price  $9  00. 


One  of  the  greatest  artistic  triumphs  of  the  age 
in  Surgical  Anatomy. — British  American  Medical 
Journal. 

No  practitioner  whose  means -will  admit  should 
fail  to  possess  it. — Ranking^s  Abstriet. 

Too  much  cannot  be  said  in  its  praise;  indeed, 
we  have  not  language  to  do  it  justice. — Ohio  Medi- 
cal and  Surgical  Journal. 

The  most  accurately  engraved  and  beautifully 
colored  plates  we  have  ever  seen  in  an  American 
book — one  of  the  best  and  cheapest  surgical  works 
ever  published. — Buffalo  Medical  Journal. 

It  is  very  rare  that  so  elegantly  printed,  bo  well 
illustrated,  and  so  useful  a  work,  is  offered  at  so 
moderate  a  price. — Charleston  Medical  Journal. 

Its  plates  can  boast  a  superiority  which  places 
them  almost  beyond  the  reach  of  competition. — Medi- 
cal Examiner. 

Country  practitioners  will  find  these  plates  of  im- 
mense value. — N.  Y.  Medical  Gazette. 


A  work  which  has  no  parallel  in  point  of  accu- 
racy and  cheapness  in  the  English  language. — N.  Y. 
Journal  of  Medicine. 

We  are  extremely  gratified  to  announce  to  the 
profession  the  completion  of  this  truly  magnificent 
work,  which,  as  a  whole,  certainly  stands  unri- 
valled, both  for  accuracy  of  drawing,  beauty  of 
coloring,  and  all  the  requisite  explanations  of  the 
subject  in  hand. — Th€  Nevt  Orleans  Medical  and 
Surgical  Journal. 

This  is  by  far  the  ablest  work  on  Surgical  Ana- 
tomy that  has  come  under  our  observation.  Wo 
know  of  no  other  work  that  would  justify  a  stu- 
dent, in  any  degree,  for  neglect  of  actual  dissec- 
tiim.  In  those  sudden  emergencies  that  so  often 
arise,  and  which  require  tlieinstantaneouscommand 
of  minute  anatomical  knowledge,  a  work  of  this  kind 
keeps  the  detiiils  of  the  dissecting-room  perpetually 
fresh  in  the  memory. — The  Western  Journal  of  Medi- 
cine and  Surgery. 


MILLER  (HENRY),  M.  D., 

Professor  of  Obstetrics  and  Diseases  of  Women  and  Cliililren  in  the  University  of  Louisville. 

PRINCIPLES  AND  PRACTICE  OF  OBSTETRICS,  &c.;  including  the  Treat- 

ment  of  Chronic  Inflammation  of  the  Cervix  and  Body  of  the  Uterus  considered  as  a  frequent 
cause  of  Abortion.     With  about  one  hundred  illustrations  on  wood.     In  one  very  handsome  oc- 
tavo volume,  of  over  600  pages.     {Lately  Fubtixhed.)     $3  75. 
We  congratulate  the  author  that  the  task  is  done.  \  tion  to  which  its  merits  justly  entitle  it.    The  style 

\y r.  n..r>n'i..>tiil.itA  liiii-i    tli.it   \^t.   li'ic?.Tiir*it,    tit   tliM   tTi«.r1i-    )    ic   ciif.ti  tli-it    tti»/l«'a^rinti(ineurA  i>1.inr     fin/1   /irir* li  ciiK- 


We  congratulate  him  that  he  has  given  to  the  medi 
cal  public  a  work  which  will  secure  for  hiin  a  high 
and  permanent  position  among  the  standard  autho- 
rities on  the  principles  and  practice  of  obstetrics. 
Congratulations  are  not  less  due  to  the  medical  pro- 
fession of  this  country,  on  the  acquisition  of  a  trea- 
tise embodying  the  results  of  the  studies,  reflections, 
anil  experience  of  Prof.  Miller.  Few  men,  if  any, 
in  this  country,  are  more  competent  than  he  to  write 
on  thisdepartrnentof  medicine.  Engaged  for  thirty- 
five  years  in  an  extended  practice  of  olistetrics,  for 
many  years  a  teacher  of  tins  branch  of  instruction 
in  one  of  the  largest  of  our  institutions,  a  diligent 
student  as  well  as  a  careful  ol)8erver,  an  original  and 
independent  thinker,  wedded  to  no  hobbies,  ever 
ready  to  consider  without  prejudice  new  views,  and 
to  adopt  innovations  if  they  are  really  improvements, 
and  withal  a  clear,  agreeable  writer,  a  practical 
treatise  from  his  pen  could  not  fail  to  possess  great 
value. — Buffalo  Med  Journal. 

In  fact,  this  volume  must  take  its  place  among  the 
Btandurti  systematic  treatises  on  obstetrics ;  a  posi- 


is  such  that  the  descriptionsare  clear,  and  each  sub- 
ject is  discussed  and  elu'idated  with  due  regard  to 
its  practical  bearings,  which  cannot  fail  to  make  it 
acceptable  and  valuable  to  both  students  and  prac- 
titioners. We  cannot,  however,  close  this  brief 
notice  without  congratulating  the  author  and  the 
profession  on  the  production  of  such  an  excellent 
treatise.  The  author  is  a  western  man  of  whom  we 
feel  proud,  and  we  cannot  but  think  that  his  book 
will  find  many  readers  and  warm  admirers  wherever 
obstetrics  is  taught  and  studied  as  a  science  and  an 
art. — The  Cincinnati  Lancet  and  Observer. 

A  most  respectable  and  valuable  addition  to  our 
home  medical  literature,  and  one  reflecting  credit 
alike  on  the  author  and  the  institution  townich  he 
is  attached.  The  student  will  find  in  this  work  a 
most  useful  guide  to  his  studies;  the  country  prac- 
titioner, rusty  in  his  reading,  can  obtain  from  its 
pages  a  fair  resume  of  the  modern  literature  of  the 
science;  and  we  hope  to  see  this  American  produc- 
tion generally  consulted  by  the  profession. —  Ya. 
Med.  Journal. 


MACKENZIE   (WJ,    M.D., 

Surgeon  Oculist  in  Scotland  in  ordinary  to  Her  Majesty,  &c.  &c. 

A  PRACTICAL   TREATISE  ON    DISEASES   AND  INJURIES  OF   THE 

EYE.  To  which  is  prefixed  an  Anatomical  Introduction  explanatory  of  a  Horizontal  Section  of 
the  Human  Eyeball,  by  Thomas  Wharton  Jones,  F.  R.  S.  From  the  Fourth  Revised  and  En- 
larged London  Edition.  With  Notes  and  Additions  by  Addinell  Hewson,  M.  D.,  Surgeon  to 
Wills  Ho>pital,  t^c.  &c.  In  one  very  large  and  handsome  octavo  volume,  leather,  raised  bands,  with 
plates  and  numerous  wood-cuts.     $5  25. 


The  treatise  of  Dr.  Mackenzie  indisputably  holds 
the  first  place,  and  forms,  in  respect  of  learning  and 
research,  an  Encyclopaedia  unequalled  in  extent  by 
any  other  work  of  the  kind,  either  English  or  foreign. 
— Dixon  on  Diseases  of  the  Eye. 

Few  modern  books  on  any  department  of  medicine 
or  surgery  have  met  with  such  extended  circulation, 
or  have  procured  for  their  authors  a  like  amount  of 
European  celebrity.  The  immense  research  which 
it  displayed,  the  thorough  acquaintance  with  the 
•ubject,  practically  as  well  as  theoretically, and  the 


able  manner  in  which  the  author's  stores  of  learning 
and  experience  were  rendered  availablefor  general 
use,  at  once  procured  for  the  first  edition,  as  well  on 
the  continent  as  in  this  country,  that  high  position 
as  a  standard  work  which  each  successive  edition 
has  more  firmly  established.  We  consider  it  tlie 
duty  of  every  one  who  has  the  love  of  his  profession 
and  the  welfare  of  his  patient  at  heart,  to  make  him- 
self familiar  with  this  the  most  complete  work  in 
the  English  language  upon  the  diseases  of  the  eye. 
— Med.  Times  and  Gazette. 


MAVNE'S  DISPENSATORY  AND  THERA- 
PEUTICAL REMEMBRANCER.  With  every 
Practical  Formula  contained  in  the  three  British 
PharmacopcEias.  Edited,  with  the  addition  of  the 
Formulae  of  the  U.  S.  Pharmacopoeia,  by  R.  E. 
Griffith, AI.D    1  12mo.  vol.  ex.cl.,300pp.  73c. 


MALGAIGNE'S  OPERATIVE  SURGERY,  based 
on  Normal  and  Pathological  Anatomy.  Trans- 
lated I'rom  the  French  by  Frederick  Brittan, 
A.  B.,M.D.  With  numerous  illustrations  on  wood. 
In  one  handsome  octavo  volume,  extra  cloth,  of 
nearly  sLs  hundred  pages.    $2  23. 


AND    SCIENTIFIC    PUBLICATIONS. 


23 


MILLER  (JAMES),  F.  R.  S.  E., 

Professor  of  Surgery  in  the  University  of  Edinburgh,  &c. 

PRINCIPLES  OF  SURGERY.     Fourth  American,  from  the  third  and  revised 

Edinburgh  edition.    In  one  large  and  very  beautiful  volume,  leather,  of  700  pages,  with  two 

hundred  and  forty  illustrations  on  wood.     i3  75. 

The  work  of  Mr.  Miller  is  too  well  and  too  favor- 
ably known  among  us,  as  one  of  our  best  text-books, 
to  render  any  further  notice  of  it  necessary  than  the 
announcement  of  a  new  edition,  the  fourth  in  our 
country,  a  proof  of  its  extensive  circulation  among 
us.  As  a  concise  and  reliable  expositi(m  of  the  sci- 
ence of  modern  surgery,  it  stands  deservedly  high — 
we  know  not  its  superior. — Boston  Med.  and  Surg. 
Journal. 


The  work  takes  rank  with  Watson's  Practice  of 
Physic;  it  certainly  does  not  fall  behind  that  great 
work  in  soundness  of  principle  or  depth  of  reason- 
ing and  research.  No  physician  who  values  his  re- 
putation, or  seeks  the  interests  of  his  clients,  can 
acquit  himself  before  his  God  and  the  world  without 
making  himself  familiar  with  the  sound  and  philo- 
sophical views  developed  in  the  forejoing  book. — 
New  Orleans  Med.  and  Surg.  Journal. 

BY  THE  SAME  AUTHOR.    {^Just  Issued.) 

THE  PRACTICE  OF  SURGERY.  Fourth  American  from  the  last  Edin- 
burgh edition.  Revised  by  the  American  editor.  Illustrated  by  three  hundred  and  sixty-four 
engravings  on  wood.     In  one  large  octavo  volume,  leather,  of  nearly  700  pages.     $.3  75. 


No  encomium  of  ours  could  add  to  the  popularity 
of  Miller's  Surgery.  Its  reputation  in  this  country 
is  unsurpassed  by  that  of  any  other  work,  and,  when 
taken  in  connection  with  the  author's  Principles  of 
Surgery,  constitutes  a  whole,  without  reference  to 
which  no  conscientious  surgeon  would  be  willing  to 
practice  his  art. —  Southern  Med.  and  Surg.  Journal. 

It  is  seldom  that  two  volumes  have  ever  made  so 
profound  an  impression  in  so  short  a  time  as  the 
"  Principles"  and  the  "  Practice"  of  Surgery  by 
Mr.  Miller — or  so  richly  merited  the  reputation  they 
have  acquired.  The  author  is  an  eminently  sensi- 
ble, practical,  and  well-informed  man,  who  knows 
exactly  what  he  is  talking  about  and  exactly  how  to 
talk  it. — Kentucky  Medical  Recorder. 

By  the  almost  unanimous  voice  of  the  profession, 


his  works,  both  on  the  principles  and  practice  of 
surgery  have  been  assigned  the  highest  rank.  If  we 
were  limited  to  but  one  work  on  surgery,  that  one 
should  be  Miller's,  as  we  regard  it  as  superior  to  all 
others. — St.  Louis  Med.  and  Surg.  Journal. 

The  author  has  in  this  and  his  "  Principles,"  pre- 
sented to  the  profession  oneof  the  most  completeand 
reliable  systems  of  Surgery  extant.  His  style  of 
writing  is  original,  impressive,  and  engaging,  ener- 
getic, concise,  and  lucid.  Few  have  the  faculty  of 
condensing  so  much  in  small  space,  and  at  the  same 
time  so  persistently  holding  theattention.  Whether 
as  a  text-book  for  students  or  a  book  of  reference 
for  practitioners,  it  cannot  be  too  strongly  recom- 
mended.— Southern  Journal  of  Med.  and  Physical 
Sciences. 


MORLAND  (W.  W.),   M.  D,, 

Fellow  of  the  Massachusetts  Medical  Society,  &c. 

DISEASES  OF  THE  URINARY  ORGANS;  a  Compendium  of  their  Diagnosis, 

Pathology,  and  Treatment.     With  illustrations.     In  one  large  and  handsome  octavo  volume,  of 
about  600  pages,  extra  cloth.     (Just  Issued.)     $3  50. 


Taken  as  a  whole,  we  can  recommend  Dr.  Mor- 
lard's  compendium  ag  a  very  desirable  addition  to 
the  library  of  every  medical  or  surgical  practi- 
tioner.— Brit,  and  For.  Med.-Chir.  Rev.,  April,  1S59. 

Every  medical  practitioner  whose  attention  has 
been  to  any  extent  attracted  towards  tlie  class  of 
diseases  to  wliich  this  treatise  relates,  must  have 
often  and  sorely  experienced  the  want  of  some  full, 
yet  concise  recent  compendium  to  which  he  could 
refer.  This  desideratum  has  been  supplied  by  L)r. 
Morland,  and  it  lias  been  ably  done.  He  has  placed 
before  us  a  full,  judicious,  and  reliable  digest. 
Each  subject  is  treated  with  sufficient  minuteness, 


yet  IB  a  succinct,  narrational  style,  such  as  to  render 
the  work  one  of  great  interest,  and  one  which  will 
prove  in  the  highest  degree  useful  to  the  general 
practitioner.  To  the  members  of  the  profession  in  the 
country  it  will  be  peculiarly  valuable,  on  account 
of  the  characteristics  which  we  have  mentioned, 
and  the  one  broad  aim  of  practical  utility  which  is 
kept  in  view,  and  which  shines  out  upon  every  page, 
together  with  the  skill  which  is  evinced  in  the  com- 
bination of  this  grand  requisite  with  tiie  utmost 
brevity  which  a  just  treatment  of  the  subjects  would 
admit. — N.  Y.  Journ.  of  Medicine,  Nov.  1658. 


MONTGOMERY  (W.  F.),    M.  D.,  M.  R.  I.  A.,  «tc., 

Professor  of  Midwifery  in  the  King  and  Queen's  College  of  Physicians  in  Ireland,  &;c. 

AN  EXPOSITION  OF  THE  SIGNS  AND  SYMPTOMS  OF  PREGNANCY. 

With  some  other  Papers  on  Subjects  connected  with  Midwifery.  From  the  second  and  enlarged 
English  edition.  Wiih  two  exf|U!site  colored  plates,  and  numerous  wood-cuts.  In  one  very 
handsome  octavo  volume,  extra  cloth,  of  nearly  600  pages.     {Lately  Published.)    $3  75. 

has  been  weighed  and  reweighed  through  years  of 
preparation;  that  this  is  of  all  others  the  book  of 
Obstetric  Law,  on  each  of  its  several  topics  ;  on  all 


A  book  unusually  rich  in  practical  suggestions. — 
Am  Journal  Med.  Sciences,  Jan.  1857. 

These  several  subjects  so  interesting  in  them- 
selves, and  so  important,  every  one  of  theui,  to  the 
most  delicate  and  precious  of  social  relations,  con- 
trolling often  the  honor  and  domestic  peace  of  a 
family,  the  legitimacy  of  offspring,  or  the  life  of  its 
parent,  are  all  treateil  with  an  elegance  of  diction, 
fulness  of  illustrations,  aeuteness  and  justice  of  rea- 
soning, unparalleled  in  obstetrics,  and  unsurpassed  in 
medicine.  The  reader's  interest  can  never  flng,  so 
fresh,  and  vigorous,  and  classical  is  our  autiior's 
style;  and  one  forgets,  in  the  renewed  charm  of 
every  page,  that  it,  and  every  line,  and  every  word 


points  connected  with  pregnancy,  to  be  everywhere 
received  as  a  manual  of  special  jurisprudence,  at 
once  announcing  fact,  affording  argument,  establish- 
ing precedent,  and  governing  alike  the  juryman,  ad- 
vocate, and  judge.  It  is  not  merely  in  its  legal  re- 
lations that  we  find  this  work  so  interesting.  Hardly 
a  page  but  that  has  its  hints  or  facts  important  to 
the  general  practitioner;  and  not  a  chapter  without 
especial  matter  for  the  anatomist,  physiologist,  or 
pathologist.  — iV.  A.  Med.-Chir.  Eevieio,  March, 
1857. 


MOHR  (FRANCIS),  PH.  D.,  AND  REDWOOD  (TH  EOPH  I  LUS). 
PRACTICx\L    PHARMACY.     Comprising  the  Arrangements,  Apparatus,  and 

JVIanipulations  of  the  Pharmaceutical  Shop  and  Laboratory.  Edited,  with  extensive  Additions, 
by  Prof  William  Procter,  of  the  Philadelphia  College  of  Pharmacy.  In  one  handsomely 
prmted  octavo  volume,  extra  cloth,  of  570  pages,  with  over  500  engravings  on  wood.    $2  75. 


24 


BLANCHARD    &    LEA'S    MEDICAL 


NEILL  (JOHN),   M.  D., 

Surgeon  to  the  Pennsylvania  Hospital, &c.;  and 

FRANCIS   GURNEY    SMITH,   M.D., 

Professor  of  Institutes  of  Medicine  in  tlie  Pennsylvania  Medical 


College. 


AN  ANALYTICAL   COMPENDIUM    OF   THE    VARIOUS    BRANCHES 

OF  MEDICAL  SCIENCE;  for  the  U^e  and  Examination  of  Students.     A  new  edition,  revised 
and  improved.     In  one  very  large  and  handsomely  printed  royal  r2mo.  volume,  of  al>uut  one 
thousand  pages,  with  374  wood-cuts.     Strongly  bound  in  leather,  with  raised  bands.     $3  00. 
The  very  flattering  reception  which  has  been  a(;corded  to  this  work,  and  the  high  estimate  placed 
upon  it  by  the  profession,  as  evinced  by  the  constant  and  increasing  demand  which  has  rapidly  ex- 
hausted two  large  editions,  have  stimulated  the  authors  to  render  the  volume  in  its  present  revision 
more  worthy  of  the  success  which  has  attended  it.     It  has  accordingly  been  thoroughly  examined, 
and  such  errors  as  had  on  former  occasions  escaped  observation  have  been  corrected,  and  whatever 
additions  were  necessary  to  maintain  it  on  a  level  with  the  advance  of  science  have  been  introduced. 
The  extended  series  ot' illustrations  has  been  still  further  increased  and  much  improved,  while,  by 
a  slia-ht  enlargement  of  the  page,  these  various  additions  have  been  incorporated  without  increasing 
the  bulk  of  the  volume. 

The  work  is,  therefore,  again  presentedaseminently  worthy  of  the  favor  with  which  it  has  hitherto 
been  received.  As  a  book  for  daily  reference  by  the  student  requiring  a  guide  to  his  more  elaborate 
text-books,  as  a  manual  for  preceptors  desiring  to  stimulate  their  students  by  frequent  and  accurate 
examination,  or  as  a  source  from  which  the  practitioners  of  older  date  may  easily  and  cheaply  acquire 
a  knowledge  of  the  changes  and  improvement  in  professional  science,  its  reputation  is  permanently 
established. 


The  best  work  of  the  kind  with  which  we  are 
acquainted. — Med.  ExaTniner. 

Having  made  free  use  of  this  volume  in  our  ex- 
aminations of  pupils,  we  can  speak  from  experi- 
ence in  recommending  it  ns  an  admirahle  compend 
for  8tu<lents,  and  as  especially  useful  to  precepture 
who  examine  their  pupils.  It  will  save  the  teacher 
much  labor  by  enabling  him  readily  to  recall  all  of 
the  points  upon  winch  his  pupils  should  be  ex- 
amined. A  work  of  this  sort  should  be  in  the  iiands 
of  every  one  who  takes  pupils  into  his  offi<'e  with  a 
viewof  examining  them  ;  and  this  is  unquestionably 
the  best  of  its  class. — Transylvania  Med.  Journal 

In  the  rapid  course  of  lectures,  where  work  for 


the  students  is  heavy,  and  review  necessary  for  an 
examination,  a  compend  is  not  only  valuable,  but 
it  is  almost  a  sine  qua  non.  The  one  before  us  is, 
in  most  of  the  divisions,  the  most  unexceptionable 
of  all  books  of  the  kind  that  we  know  of.  The 
newest  and  soundest  doctrines  and  the  latest  im- 
provements and  discoveries  are  explicitly,  though 
cimcisely,  laid  before  the  stuilent.  Tiiere  is  a  class 
to  whom  we  very  sincerely  commend  this  cheap  book 
as  worth  its  weight  in  silver — that  class  is  the  gradu- 
ates in  medicine  of  more  than  ten  years'  stamling, 
who  have  not  studied  medicine  since.  Tliey  will 
perhaps  find  out  from  it  that  the  science  is  not  exactly 
now  what  it  was  when  they  left  it  off. — The  Stetho- 
scopt. 


NELIGAN  (J.    MOORE),  M.  D.,  M .  R.  I.  A.,  &.C. 

[A  splendid  work.     Just  Issued.) 

ATLAS  OF  CUTANEOUS  DISEASES.     la  one  beautiful  quarto  volume,  extra 

cloth,  with  splendid  colored  plates,  presenting  nearly  one  hundred  elaborate  representations  ol 

disease.     $4  50. 

This  beautiful  volume  is  intended  as  a  complete  and  accurate  representation  of  all  the  varieties 
of  Diseases  of  the  Skin.  While  it  can  lie  consulted  in  conjunction  with  any  work  on  Practice,  it  has 
especial  reference  to  the  author's  "  Treatise  on  Diseases  of  the  Skin,"  so  favorably  received  by  the 
profession  some  years  since.  The  publishers  feel  justified  in  saying  that  few  more  beautifully  exe- 
cuted plates  have  ever  been  presented  to  the  profession  of  this  country. 

Neligan's  Atlas  of  Cutaneous  Diseases  supplies  a  I  give,  at  a  couji  d^aeil,  the  remarkable  peculiarities 
long  existent  desideratum  much  felt  by  the  largest  of  each  inilividual  variety.  And  while  thus  tlie  dis- 
class 'if  our  profession.  It  presents,  in  quarto  size,  ease  is  rendered  more  definable,  there  is  yet  no  loss 
16  plates,  each  containing  from  3  to  6  figures,  ana  j  of  proportion  incurred  by  the  necessary  concentra- 
forining  in  all  a  total  of  90  ili8lin''t  representations  j  tion.  Each  figure  is  highly  colored,  anil  so  truthful 
of  the  different  species  of  skin  affections,  grouped  h:i8  ihe  artist  tieen  ihatthe  mostfastid  ous  oliserver 
together  in  genera  or  families.  The  illustrations  [  could  not  justly  lake  exception  to  the  correctness  of 
have  been  taken  from  nature,  and  have  leen  copied  the  executiim  of  the  pictures  under  his  scrutiny. — 
with  such  fidelity  that  they  present  a  striking  picture  |  Montreal  Med.  Chronicle. 
of  life;  in  which  the  reduced  scale  aptly  serves  to  I 

BY  THE  SAME  AUTHOR. 

A    PRACTICAL   TREATISE    ON    DISEASES   OF  THE    SKIN.      Third 

American  edition.     In  one  neat  royal  12mo.  volume,  extra  cloth,  of  -334  pages.     $1  00. 

The  two  volumes  will  be  sent  by  mail  on  receipt  of  Five  Dollars. 


OWEN  ON  THE  DIFFERENT  FORMS  OF 
THE  SKELKTON,  AND  OF  THE  TEETH. 


One  vol.  royal  12mo.,  extra  cloth  with  numerous 
illustrations.    $1  25. 


PIRRIE  (WILLIAM),  F.  R.  S.  E., 

Professor  of  Surgery  in  the  University  of  Aberdeen. 

THE    PRINCIPLES  AND  PRACTICE  OF  SURGERY.     Edited  by  John 

Neill,  M.  D.,  Professor  of  Surgery  in  the  Penna.  Medical  College,  Surgeon  tothe  Pennsylvania 
Hospital,  &c.  In  one  very  handsome  octavo  volume,  leather,  ol  780  pages,  with  316  illustrations. 
$3  75. 


We  know  of  no  other  surgical  work  of  a  reason- 
able size,  wherein  there  is  so  much  theory  and  prac- 
tice, or  where  subjects  are  more  soundly  or  clearly 
taught. — Tke  Stethoscope. 

Prof.  Pirrie,  in  the  work  before  us,  has  elabo- 


rately discussed  the  principles  of  surgery,  and  a 
safe  and  effectual  practice  predicated  upr)n  them. 
Perhaps  no  work  upon  this  subject  heretofore  issued 
is  so  full  upon  the  science  of  the  art  of  surgery. — 
Is'ashville  Journal  of  Medicine  and  Surgery, 


AND   SCIENTIFIC    PUBLICATIONS. 


25 


PARRISH    (EDWARD), 

Lecturer  on  Practical  Pharmacy  and  Materia  Medica  in  the  Pennsylvania  Academy  of  Medicine  Ac 

AN  INTRODUCTION  TO  PRACTICAL  PHARMACY.  Designed  as  a  Text- 
Book  for  the  Student,  and  as  a  Guide  for  the  Physician  and  Pharmaceutist.  With  many  For- 
mulse  and  Prescriptions.  Second  edition,  greatly  eularsed  and  improved.  In  one  handsome 
octavo  volume  of  720  pages,  with  several  hundred  Illustrations,  extra  cloth.  $3  50.  (Ju/i 
Issiced.)  ^ 

Duiiijg  the  short  time  in  which  this  work  ha?  been  before  the  profession,  it  has  been  received 
with  veiy  great  favor,  and  in  assuming  the  position  of  a  standard  authority,  it  has  filled  a  vacancy 
which  had  been  severely  felt.  Stimulated  by  this  encouragement,  the  author,  in  availing  himself 
of  the  opportunity  of  revision,  has  spared  no  pains  to  render  it  more  vi^oithy  of  the  confidence  be- 
stowed upon  it,  and  his  assiduous  labors  have  made  it  ra.her  a  new  book  ihan  a  newedilion,  many 
portion>  having  been  rewritten,  and  much  new  and  important  matter  added.  These  alterations  and 
improvements  have  been  rendered  necessary  by  the  rapid  progress  made  by  pharmaceutical  science 
during  the  last  few  years,  and  by  the  additional  experience  obtained  in  the  practical  use  of  the 
volume  as  a  text-book  and  work  of  reference.  To  accommodate  these  improvements,  the  size  of 
the  page  has  been  materially  enlarged,  and  the  number  of  pages  considerably  increased,  presentin<^ 
in  all  nearly  oiu-half  more  matter  tlian  the  last  edition.  The  work  is  therefore  now  presented  as  a 
complete  exponent  of  the  subject  in  its  most  advanced  condition.  From  the  most  ordinary  matters 
in  the  dispensing  office,  to  the  most  complicated  details  of  the  vegetable  alkaloids,  it  is  hoped  that 
everything  requisite  to  the  pracli^lng  physician,  and  to  the  apothecary,  will  be  found  fully  and 
clearly  set  forth,  and  that  the  new  matier  alone  will  be  worih  more  than  the  very  moderate  cost  of 
the  work  to  those  who  have  been  consulting  the  previous  edition. 


That  Edward  Parrish,  in  writing  a  boolc  upon 
practical  Pharmacy  sonit  few  years  ago — one  emi- 
nently original  Hiid  unique — did  the  medical  and 
pharmaceutical  professions  a  grea^  and  v.ilualile  ser- 
vice, no  one,  we  think,  wlio  has  had  access  to  its 
pages  will  deny  ;  doubly  welcome,  then,  is  this  new 
edition,  containing  the  Hdded  results  of  his  recent 
and  rich  experience  as  an  observer,  teacher,  and 
practic  .1  (n'crator  in  ihf  pharmaceutical  laboratory 
The  excellent  plan  of  the  first  is  more  thoroughly, 
and  in  detail,  carried  out  in  this  edition. — Peninsular 
Med   Journal,  Jan.  18G0. 

Of  course,  all  apothi  caries  who  have  not  already 
a  copy  of  the  first  edition  will  procure  (me  of  this; 
it  is,  ilierefore,  to  physicians  residing  in  the  country 
and  in  small  towns,  who  cannot  avail  themselves  of 
the  skill  of  an  educated  pharmaceutist,  that  wt 
would  espi daily  commend  this  work.     In  it  they 


will  find  all  that  they  desire  to  know,  and  should 
know,  but  very  little  of  which  they  do  really  <now 
in  reference  to  this  impoilant  c<Mlateral  branch  of 
their  profession;  for  it  is  a  well  estahlislied  fact, 
lliat,  in  the  ei  u''ation  oi  physicians,  while  the  sci- 
ente  of  medicine  is  generally  well  taught,  very 
little  attention  is  paid  to  the  art  of  preparing  them 
for  use,  and  we  know  not  how  tnis  defect  can  be  so 
well  remedied  as  by  procuring  and  consulting  Dr. 
Pa  rrish's  excellent  work. — St.  Louis  Med.  Journal 
Jan    1860. 

We  know  of  no  work  on  the  subject  which  would 
be  more  indispensable  to  the  phjsician  or  stu'lent 
desiring  information  on  the  subject  of  which  it  treats. 
VViih  Griffith's  "  Medicil  Formulary"  and  this,  the 
practising  physician  would  be  supplied  with  nearly 
or  quite  all  the  most  ujeful  infor  nation  on  the  sub- 
ject.— Charleston  Med.  Jour,  and  Review,  Jan.  ISOO 


PEASLEE  (E.  R.),   M.  D., 

Professor  of  Physiology  and  General  Pathology  in  the  New  York  Medical  College. 

HUMAN  HISTOLOGtY,  in  its  relations  to  Anatomy,  Physiology,  and  Pathology; 
for  the  use  of  Medical  Students.  With  four  hundred  and  thirty- four  illustrations.  In  one  hand- 
some octavo  volume,  of  over  600  pages.     (Lately  Published.')     $3  75. 

We  would  recommend  it  to  the  medical  student 
and  practitioner,  as  containing  a  summary  of  all  that 
is  known  of  the  important  subjects  which  it  treats; 
of  all  that  is  contained  in  the  great  works  of  Simon 
and  Lehmann,  and  the  organic  chemists  in  general. 
Master  this  one  volume,  we  would  say  to  the  mtdical 
student  and  practitioner — master  this  book  and  you 
know  all  that  is  known  of  the  great  fundamental 
principles  of  medicine,  and  we  liave  eo  hesitation 
in  saying  that  it  is  aa  honor  to  the  American  medi- 
cal professiim  that  one  of  its  members  should  have 
produced  it. — St.  Louis  Med.  and  Surg.  Journal, 
March,  1«58. 


It  embraces  a  library  upon  the  topics  discussed 
within  Itself,  and  is  just  whatthe  teaclierand  learner 
need.  Another  advantage,  by  no  means  to  be  over- 
looked, everything  of  real  value  in  the  wide  range 
which  it  embraces,  is  with  great  skill  compressed 
into  an  octavo  volume  of  but  little  more  than  six 
hundred  pages.  We  have  not  only  the  whole  sub- 
ject of  Histology,  interesting  in  itself, ably  and  fully 
discussed,  but  what  is  ol  infinitely  greater  interest 
to  the  student,  because  of  greater  practical  value, 
are  its  relations  to  Anatomy,  Physiology,  and  Pa- 
thology, which  are  here  fully  and  satisfactorily  set 
ioxth.— JSashiiille  Journ.  of  Med.  and  Surgery,  Dec. 
1857. 


PEREIRA  (JONATHAN),  M .  D.,  F.  R.  S.,  AND  L.  S. 
THE    ELEMENTS    OF    MATERIA    MEDICA    AND    THERAPEUTICS. 

Third  American  edition,  enlarged  and  improved  by  the  author;  incUiding  Notices  of  most  of  the 
Medicinal  Substances  in  use  in  the  civilized  world,  and  forming  an  Encyclopnedia  of  Materia 
Medica.  Edited,  with  Additions,  by  Joseph  Cakson,  M.  U.,  Professor  of  Materia  Medica  and 
Pharmacy  in  the  University  of  Peniisylvania.  In  two  very  large  octavo  volumes  of  2100  pages, 
on  small  type,  with  about  500  illustrations  on  stone  and  wood,  strongly  bound  iu  leather,  with 
raised  bands.  $y  00. 
**jt  Vol.  II.  will  no  longer  be  sold  separate. 


PARKER   (LANGSTON), 

Surgeon  to  the  Queen's  Hospital,  Birmingham. 

THE  MODERN  TREATMENT  OF  SYPHILITIC  DISEASES,  BOTH  PRI- 

MARY  AND  ^CONUARY;  comprisingtheTreatment  of  Constitutional  and  Confirmed  Syphi- 
lis by  a  safe  and  successful  method.  With  numerous  Cases,  Formulae,  and  Clinical  Observa- 
tions. From  the  Third  and  entirely  rewritten  London  edition.  In  one  neat  octavo  volume, 
extra  cloth,  of  316  pages.     $175. 

ROYLE'S    MATERIA   MEDICA   AND   THERAPEUTICS;   including  the 

Preparations  of  the  Pharmacopoeias  of  London,  Edinburgh,  Dublin,  and  of  the  United  States. 
With  many  new  medicines.  Edited  by  Joseph  Carson,  M.  D.  ^With  ninety-eight  illustrations. 
In  one  large  octavo  volume,  extra  cloth,  of  about  700  pages.     $•"  00. 


26 


BLANCHARD    &    LEA'S    MEDICAL 


RAMSBOTHAM  (FRANCIS  H.),   M.D. 
THE  PRINCIPLES  AND  PRACTICE  OF  OBSTETRIC  MEDICINE  AND 

SURGERY,  in  reference  to  the  Process  of  Parturition.  A  new  and  enlarged  edition,  thoroughly 
revii^ed  by  the  Author.  With  Additions  by  W.  V.  Keating,  M.  D.,  Professor  of  Obstetrics,  &:c.,  in 
the  Jefferson ^ledical  College,  Philadelphia.  In  one  large  and  handsome  imperial  octavo  volume, 
of  650  pages,  strongly  bound  in  leather,  with  raised  bands;  vf'ilh  sixty  four  beautiful  Plates,  and 
numerous  Wood-cuts  in  the  text,  containing  in  all  nearly  200  large  and  beautiful  figures.   $-5  00. 

From  Prof.  Hodge,  of  the  University  of  Pa. 
To  the  American  public,  it  is  most  valuable,  from  its  intrinsic  undoubted  excellence,  and  as  being 
the  best  authorized  exponent  of  British  Midwifery.    Its  circulation  will,  1  trust,  be  extensive  throughout 
our  country. 

It  is  unnecessary  to  say  anything  in  regard  to  the  |  truly  elegant  style  in  which  they  have  brought  it 

out,  excelling  tliemselves  in  its  production,  espe- 
cially in  its  plates.  It  is  dedicated  to  Prof.  iMeigs, 
and  has  the  emphatic  endorsement  of  Prof.  Hodge, 
as  the  best  exponent  of  British  Midwifery.  We 
knuw  of  no  text-book  which  deserves  in  all  respects 
to  be  more  highly  recommended  to  students,  and  we 
could  wish  to  see  it  in  the  handsof  every  practitioner, 
for  they  will  find  it  invaluable  for  reference. — Med. 
Gazette. 


utility  of  this  work.  It  is  already  appreciated  in  our 
country  for  the  value  of  the  matter,  the  clearness  of 
its  style,  and  the  fulness  of  its  illustrations.  To  the 
physician's  library  it  is  indispensable,  while  to  the 
student  as  a  text-book,  from  which  to  extract  the 
material  for  laying  the  foundation  of  an  education  on 
obstetrical  science,  it  has  no  superior. — Ohio  Med. 
and  Surg.  Journal. 
The  publishers  have  secured  its  success  by  the 


RICORD  (P.),   M.  D. 
A  TREATISE  ON  THE  VENEREAL  DISEASE.     By  John  Hunter,  F.  R.  S. 

With  copious  Additions,  by  Ph.  Ricord,  M.  D.    Translated  and  Edited,  with  Notes,  by  Freema?j 
J.  BuMSTEAD.  iVl.  D.,  Lecturer  on  Venereal  at  the  College  of  Physicians  and  Surgeons,  New  York. 
Second  edition,  revised,  containing  a  risumi  of  Ricokd's  Recent  Lectures  on  Chancre.     Tn 
one  handsome  octavo  volume,  extra  cloth,  of  550  pages,  with  eight  plates.    $3  25.    (Just  hsiied.) 
In  revising  this  work,  the  editor  has  endeavored  to  introduce  whatever  matter  of  interest  the  re- 
cent investigations  of  syphilographers  have  added  to  our  knowledge  of  the  subject.     The  principal 
source  from  which  this  has  been  derived  is  the  volume  of  "Lectures  on  Chancre,"  published  a  lew 
months  since  by  M.  Rioord,  which  affords  a  large  amount  of  new  and  instructive  material  on  many 
controverted  points.     In  the  previous  edition,  M.  Ricord's  additions  amounted  to  nearly  one-third 
of  the  whole,  and  with  the  matter  now  introduced,  the  work  may  be  considered  to  present  his  views 
and  experience  more  thoroughly  and  completely  than  any  other. 

secretaries,  sometimes  accredited  and  sometimes  not. 
In  the  notes  to  Hunter,  the  master  subsuiutes  him- 
self forhis  interpreters,  and  give?  hisorigiiial  llioughis 
to  the  world  in  a  lucid  and  perfectly  iiitelligi hie  man- 


Every  one  will  recognize  the  attractiveness  and 
ralue  which  this  work  derives  from  thus  presenting 
the  opinions  of  these  two  masters  side  by  side.  But. 
it  must  be  admitted,  what  has  made  the  fortune  of 
the  book,  is  the  fact  that  it  coiuains  the  "most  com- 
plete embodimeiil  of  the  veritable  doctrines  of  the 
HOpiial  du  Midi,"  which  has  ever  been  made  public. 
The  doctrinal  ideas  of  Al.  Ricord.  ideas  which,  if  not 
universally  adopted. are  incontestably  dominant,  have 
heretofore  only  been  interpreted  by  more  or  less.>.kilfu  I 


uer.  In  conclusion  we  can  say  that  this  is  incon- 
testably the  best  treatise  on  syphilis  wiih  which  we 
are  acquainted,  and,  as  we  do  iiol  often  employ  the 
phrase,  we  may  he  excused  for  expressing  ilie  hope 
that  it  may  find  a  place  in  the  library  of  every  phy- 
sician.—  Virginia  Med.  and  Surg.  Journal. 


BY    THE  SAME   AUTHOR. 

RICORD'S  LETTERS  ON  SYPHILIS.   Translated  by  W.  P.  Lattimore,  M.  D. 

In  one  neat  octavo  volume,  of  270  pages,  extra  cloth.    %i  00. 

SLADE  (O.  D.),   M.  D. 
DIPHTHERIA ;  its  Nature  and  Treatment,  with  an  Account  of  the  History  of  its 

Prevalence  in  various  countries.     Being  the  Dissertation  to  which  the  Fiske  Fund  Prize  was 
awarded,  July  11,  IS60.    In  one  small  octavo  volume,  extra  cloth;  75  cents.   (Now  Reaily,  1801.) 

ROKITANSKY   (CARL),    M.D., 

Curator  of  the  Imperial  Pathological  Museum,  and  Professor  at  the  University  of  Vienna,  &c. 

A    MANUAL   OF  PATHOLOGICAL 

bound  in  two.  extra  cloth,  of  about  1200  pages. 

KING,  C.  H.  Moore,  and  G.  E.  Day.     $5  50. 

The  profession  is  too  well  acquainted  with  the  re- 
putation of  Rokitansky's  work  to  need  our  assur- 
ance that  this  is  one  of  the  most  profound,  thorough, 
and  valuable  books  ever  issued  from  tne  meilical 
press.  It  is  iui  generis,  and  has  no  standard  of  com- 
parison. It  is  only  necessary  to  announce  that  it  is 
issued  in  a  form  as  cheap  as  is  compatible  with  its 
size  and  preservation,  and  its  sale  follows  as  a 
matter  of  course.  No  library  can  be  called  com- 
plete without  it. — Buffalo  Med.  Journal. 

An  attempt  to  give  our  readers  any  adequate  idea 
of  the  vast  amount  of  instruction  accumulated  in 
these  volumes,  would  be  feeble  and  hopeless.  The 
effort  of  the  distinguished  author  to  concentrate 
in  a  small  space  his  great  fund  of  knowledge,  has 


ANATOMY.     Four  volumes,   octavo, 

Translated  by  W.  E.  Swaine,  Edward  Sieve- 
so  charged  his  text  with  valuable  truths,  that  any 
attempt  of  a  reviewer  to  epitomize  is  at  once  para- 
lyzed, and  must  end  in  a  failure. —  Western  Lancet. 
As  this  is  the  highest  source  of  knowledge  upon 
the  important  subject  of  which  it  treats,  no  real 
student  can  afford  to  be  without  it.  The  American 
publishers  have  entitled  themselves  to  the  thanks  of 
the  profession  of  their  country,  for  this  timeous  and 
beautiful  edition. — Nashville  Journal  of  Meilicine. 

As  a  book  of  reference,  therefore,  this  work  niust 
prove  of  inestimable  value,  and  we  cannot  too  highly 
recommend  it  to  the  profession. —  Charleston  Med. 
Journal  and  Kevieu). 

This  book  is  a  necessity  to  every  practitioner. — 
Am.  Med.  Monthly. 


RIGBY   (EDWARD),    M.D., 

Senior  Physician  to  the  General  Lying-in  Hospital,  kc. 

A    SYSTEM    OF    MIDWIFERY.     With  Notes  and  Additional  lUustrations. 

Second  American  Edition.     One  volume  octavo,  extra  cloth,  422  pages.     $2  50. 
BY  THE  same  AUTHOR.     (Lately  Published.) 

ON  THE  CONSTITUTIONAL  TREATMENT  OF  FEMALE  DISEASES. 

In  one  neat  royal  12mo.  volume,  extra  cloth,  of  about  250  pages.    $1  00. 


AND    SCIENTIFIC    PUBLICATIONS. 


27 


STILLE  (ALFRED),    M.D. 
THERAPEUTICS  AND  MATERIA  MEDIC  A;  a  Systematic  Treatise  on  the 

Action  and  Uses  of  Medicinal  Ag-ents,  including  their  Description  and  History.    In  two  lar"-e 
and  handsome  octavo  volumes,  ot  17S9  pages.     {Just  Issued,  i860.)     $8  00.  ° 

This  work  is  designed  especially  for  the  student  and  practitioner  of  medicine,  and  treats  the  various 
articles  of  the  Materia  Medica  from  the  point  of  view  of  the  bedside,  and  not  of  the  shop  or  o(  the 
leciure-room.  While  thus  endeavoring  to  give  all  practical  information  likely  to  be  useful  with 
respect  to  the  employment  of  special  remedies  in  special  allections,  and  the  results  to  be  amicipated 
/rom  their  administration,  a  copious  Index  of  Diseases  and  their  Remedies  renders  the  work  emi- 
nently fitted  for  reference  by  showing  at  a  glance  ihe  different  means  which  have  been  emploved, 
and  enabling  the  practitioner  to  extend  his  resources  in  difficult  cases  with  all  that  tiie  experience 
of  the  profession  has  suggested. 


Rarely,  indped,  have  we  had  submitted  to  us  a 
work  on  medicine  so  ponderous  in  its  dimensions 
as  that  now  before  us,  and  yet  so  fascinating  in  its 
contents.  It  is,  therefore,  with  a  peculiar  gratiti- 
Crttion  that  we  recognize  in  Dr.  Siille  the  posses- 
sion of  many  of  those  more  distinguished  qualifica- 
tions which  entitle  him  to  approbation,  and  which 
justify  him  in  coming  before  his  medical  bretliren 
iis  an  instructor.  A  comprehensive  knowledge, 
tested  by  a  sound  and  penetrating  judgment,  joined 
to  a  love  of  progress  — which  a  discriminating  spirit 
of  inquiry  has  tempered  so  as  to  accept  nothing  new 
because  it  is  new,  and  abandon  nothing  old  because 
it  is  old,  but  whicti  estimates  either  accort  ing  to  its 
relations  to  a  just  logic  and  experience — m;inifeFts 
itself  everywhere,  and  gives  to  the  guidance  of  tlie 
author  all  iie  assurance  of  safety  which  ihe  diffi- 
culties of  his  subject  can  allow.  In  conclusion,  we 
earnestlv  advise  our  readers  to  ascertain  for  them- 
selves, by  a  study  of  Dr.  StiUe's  volumes,  the  great 
value  and  interest  of  the  stores  of  knowledge  they 
present.  We  have  pleasure  in  referring  raiher  to 
the  ample  treasury  of  undoubted  truths,  the  real  and 
jissured  conquest  of  medicine,  accumulated  by  Dr. 
Stille  in  his  pages  ;  and  commend  the  sum  of  his  la- 
bt)rs  to  the  attention  of  our  readers,  as  alike  honor- 
able to  our  science,  and  creditable  to  the  zeal,  the 
candor,  and  the  judgment  of  him  who  has  garnered 
the  whole  so  carefully. — Edinburgh  Med.  Journal. 

Our  expectations  of  the  value  of  this  work  were 
based  on  the  well-known  reputation  and  character 
of  the  author  as  a  man  of  scholarly  attainments,  an 
elegant  writer,  a  candid  inquirer  after  truth,  and  a 
philosophical  thinker  ;  we  knew  that  the  task  would 
be  conscientiously  performed,  and  that  itvf,  if  any, 
among  the  distinguished  medical  teachers  in  this 
country  are  better  qualified  than  he  to  prepare  a 
systen  atic  treatise  on  therapeutics  in  accordance 
with  the  present  requirements  of  medical  science. 
Our  preliminary  examination  of  the  work  has  satis- 


fied us  that  we  were  not  mistaken  in  our  anticipi- 
lions.—Ntiv  Orleans  Medical  News,  March,  IsGO. 

The  most  recent  authority  is  the  one  last  men- 
tioned, Stille.  His  great  work  on  ''  Materia  Medi- 
ca and  Therapeutics,"  published  last  year,  in  two 
octavo  volumes,  of  some  sixteen  hundred  pages, 
while  it  embodies  the  results  of  the  l^bor  of  others 
up  to  the  time  of  pul)lication,  is  enriched  with  a 
great  amount  of  original  observation  and  research. 
We  would  draw  attention,  by  the  way,  to  the  very 
c<mvenient  mode  in  which  the  Inrhx  is  arranged  in 
this  work.  There  is  firstan  "  Index  of  Remedies  ;" 
next  an  "Index  of  Diseases  and  their  Remedies." 
Such  an  arrangement  of  the  Indices,  in  our  oninion, 
greatly  enhances  the  practical  value  of  books  of  ihis 
kind.  In  tedious,  obstinate  cases  of  disease,  where 
we  have  to  try  ime  remedy  after  another  until  our 
stock  is  pretty  nearly  exhausted,  and  we  are  almost 
driven  to  our  wit's  end,  such  an  inde.x  as  the  second 
of  the  two  just  mentKmed,  is  precisely  what  we 
want. — London  Med.  Times  and  Gazette,  April,  1*-C1. 

AVe  think  this  work  will  do  much  to  obviate  the 
reluctance  to  a  thorough  investigation  of  this  branch 
of  scientific  study,  for  in  the  wide  range  of  medical 
literature  treasured  in  the  English  tongue,  we  shall 
hardly  find  a  work  written  in  a  style  more  clear  and 
simple.  Conveying  forcibly  the  facts  taught,  and  yet 
free  from  turgidity  and  redundancy.  There  is  a  fas- 
cination in  its  pages  that  will  insure  to  it  a  wide 
popularity  and  attentive  perusal,  and  a  deiriee  of 
usefulness  not  often  attained  through  the  influence 
of  a  single  work.  The  author  has  much  enhanced 
the  practical  utility  of  his  book  by  passing  briefly 
over  the  physical,  botani  !al,  aiid  comuiereial  history 
of  medicines,  and  directing  attentnm  chiefly  to  their 
physiological  action,  and  their  applicati<m  for  the 
amelioration  or  cure  of  disease.  He  i^n  ires  hypothe- 
sis and  theory  which  are  so  alluring  to  many  medical 
writers,  and  so  liable  to  lead  them  astray,  and  con- 
fines himself  to  such  facts  as  have  been  tried  in  the 
crucible  of  experience. — Chicago  Medical  Journal. 


SMITH    (HENRY    H.),   M.D. 

MINOR  SURGERY;  or,  Hints  on  the  Every-day  Duties  of  the  Surgeon.     With 

247  illustrations.    Third  edition.    1  vol.  royal  12mo.,  pp.  456.    In  leather,  $2  25;  cloth,  $2  00. 

BY   THE   SAME   AUTHOR,   AND 

HORNER  (WILLIAM  E.),   M.D., 

Late  Professor  of  Anatomy  in  the  University  of  Pennsylvania. 

AN  ANATOMICAL  ATLAS,  illustrative  of  the  Structure  of  the  Human  Body. 

In  one  volume,  large  imperial  octavo,  extra  cloth,  with  about  six  hundred  and  fifty  beautilul 
figures.     $3  00. 


These  figures  are  well  selected,  and  present  a 

complete  and  accurate  representation  of  that  won- 
derful fabric,  the  human  body.  The  plan  of  this 
Atlas,  which  renders  it  so  peculiarly  convenient 
for  the  student,  and  its  superb  artistical  execution, 
have  been  already  pointed  out.     We  must  ccmgratu- 


late  the  student  upon  the  completion  of  thisAtlas' 
as  it  is  the  most  convenient  work  of  the  kind  that 
has  yet  appeared  ;  and  we  must  add,  the  very  beau- 
tiful manner  in  which  it  is  "got  up"  is  so  creditable 
to  the  country  as  to  be  flattering  to  our  national 
pride. — American  Mtdizal  Journal. 


SHARPEY  (WILLIAM),   M.D.,   JONES   QUAIN,   M.  D.,  AND 

RICHARD   QUAIN,    F.  R.  S.,  &.C. 

HUMAN  ANATOMY.     Revised,  with  Notes  and  Additions,  by  Joseph  Letdy, 

M.  D.,  Professor  of  Anatomy  in  the  University  of  Pennsylvania.  Complete  in  two  large  octavo 
volumes,  leather,  of  about  thirteen  hundred  pages.  Beautifully  illustrated  with  over  five  hundred 
engravings  on  wood.     $6  00. 

SIMPSON  (J.  Y.  ,   M.  D., 

Professor  of  Midwifery,  &c.,  in  the  University  of  Edinburgh,  &c. 

CLINICAL  LECTURES  ON  THE  DISEASES  OF  FEMALES.    With  numc- 

rous  illustrations. 

This  valuable  series  of  practical  Lectures  is  now  appearing  in  the  "Medical  News  and 
Library"  for  1S60  and  1861,  and  can  thus  be  had  without  cost  by  subscribers  to  the  "American 
Journal  of  the  Medical  Sciences."    See  p.  2. 


28  BLANCHARD    &   LEA'S    MEDICAL 


SARGENT  (F.  W.),   M.  D. 
ON  BANDAGING  AND  OTHER  OPERATIONS  OF  MINOR  SURGERY. 

Second  edition,  enlarged.     One  handsome  royal  12mo.  vol.,  of  nearly  400  pages,  wilb  182  wood- 
cuts.    Extra  cloth,  $1  40;  leather,  $1  50. 

A  work  that  has  been  bo  long  and  favorably  known 
to  the  profession  ns  Dr.  Sargent's  Minor  Surgery, 
needs  no  commendation  from  us.  We  would  remark, 
however,  in  this  connection,  that  minor  surgery  sel- 
dom gets  that  attention  in  our  schools  that  its  im- 
portance deserves.  Our  larger  works  are  also  very 
defective  in  their  teaching  on  these  small  practical 
points.  This  little  book  will  supply  the  void  which 
all  must  feel  who  have  not  studied  its  pages. — West- 
ern Lancet. 


Sargent's  Minor  Surgery  has  always  been  popular, 
and  deservedly  so.  It  furnishesthatknowledgeof  the 
most  frequently  requisite  performances  of  surgical 
art  which  cannot  be  entirely  understood  by  attend- 
ing clinical  lectures.  The  art  of  bandaging,  which 
is  regularly  taught  in  Europe,  is  very  frequently 
overlooked  by  teachers  in  this  country  ;  the  student 
and  junior  practitioner,  therefore,  may  often  require 
tha.t  knowledge  which  this  little  volume  so  tersely 
and  happily  supplies. — Charleston  Med.  Journ.  and 
Review. 


SMITH   (W.   TYLER),   M.  D., 

Physician  Accoucheur  to  St.  Mary's  Hospital,  &c. 

ON   PARTURITION,   AND   THE    PRINCIPLES    AND   PRACTICE    OF 

OBSTETKIGS.    In  one  royal  12mo.  volume,  extra  cloth,  of'400  pages.    $1  25. 

BY  THE  SAME  AUTHOR. 

A  PRACTICAL  TREATISE  ON  THE  PATHOLOGY  AND  TREATMENT 

OF  LEUCORKHCEA.    With  numerous  illustrations.    In  one  very  handsome  octavo  volume, 
extra  cloth,  ol  about  250  pages.     $1  50. 

SOLLY  ON  THE  HUMAN  BRAIN;  its  Structure.  |  handsome  octavo  volume,  extra  cloth,  of  over  650 
Physiology,  and  Diseases.  Fro.-n  the  Second  ana  pages,  with  about  one  hundred  wood-cuts.  $3  25. 
much  enlarged  L<mdon  editnm.  In  one  octave  gij^iON-!*  GENERAL  PATHOLOGY,  as  eonduc- 
volume.  extra  cloth,  of  500  pages,  with  120  wood-  j^e  to  the  Establishn.cut  of  Raticmal  Principles 
cuts.     $'2  00.  for  the  prevention  aiio  Cure  of  Uisease.    In  one 

SKEY'S  OPERATIVE  SURGERY.    In  one  very  '      octavo  volume,  extra  clolh,  of  212  pages.    $125. 

TANNER   (T.    H.),    M.  D., 

Physician  to  the  Hospital  for  Women,  &c. 

A  MANUAL  OF  CLINICAL  MEDICINE  AND  PHYSICAL  DIAGNOSIS. 

To  which   is  added  The  Code   of  Ethics   of   the  American    Medical  Association.     Second 
American  Edition.    In  one  neat  volume,  small  r2mo.,  extra  cloth,  87^  cents. 

TAYLOR  (ALFRED  S.),  M.  D.,  F.  R.  S., 

Lectureron  Medical  Jurisprudence  and  Chemistry  in  Guy's  Hospital. 

MEDICAL  JURISPRUDENCE.     Fifth  American,  from  the  seventh  improved 

an(*  enlarged  London  edition.  With  Notes  and  References  to  American  Decisions,  by  Edward 
Hartshorne,  M.  D.  In  one  large  octavo  volume,  leather,  of  over  700  pages.  {Nearly  Ready.) 
This  .standard  work  having  had  the  advantage  of  two  revii-ions  at  the  hands  oflhe  auihor  since 
the  appearance  of  the  last  American  edition,  will  be  found  thoroughly  revi>ed  and  brought  up  com- 
pletely to  the  present  *taie  of  the  science.  As  a  work  of  auihomy,  it  must  therefore  mainiaiii  iis 
position,  both  as  a  text-book  for  the  student,  and  a  compendious  treatise  to  which  the  practitioner 
can  at  all  times  refer  in  cases  of  doubt  or  dilficully. 

No  work  upon  the  subject  can  be  put  into  the  >  American  and  British  legal  medicine.  It  should  be 
bands  of  students  either  of  law  or  medicine  which  in  the  possession  of  every  physiciHn,  as  the  subject 
will  engage  them  more  closely  or  profitably;  and  is  ore  of  great  and  increasing  importunee  to  the 
none  could  be  oflered  to  the  busy  practitioner  of  public  as  well  as  to  the  profession.— 6«.  i-o«t«  Aferf. 
either  calling,  for  the  purpose  of  casual  or  hasty  and  Surg.  Journal. 
reference,  that  would  be  more  likely  toafford  the  aid  ,  ,     ,  t^     r„     ,     ,    • 

desired.     We  therefore  recommend  it  as  the  best  and     ,   T"'?  "^Z^^  ^'  ^J-  Baylor's  la  generally  acknow- 


Med 


fest  manual  for  daily  \xst.—Amtritan  Journal  oj    lodged  to  be  one  of  the  ablest  extant  on  the  subject 
edical  Sciences.  of  medical  jurisprudence,     it  is  certainly  one  ol  the 


,        .       ._        .  »k»i.  »k....„i.,.^«  most  attractive  books  that  we  have  met  with  :  sup- 

It  IS  not  excess  of  praise  to  say  that  the  volume  ,          g„  ^„p,,  ,,„jj,  j„  interest  and  instruct,  that 

before  us  IS  the  very  best  treatise  extant  on  Medical  ^e  do  not  hesitate  to  athrm  that  after  having  once 

Jurisprudence.    In  saying  this,  we  do  not  wish  to  commenced  Us  perusal,  few  could  be  prevailed  upon 


It  is  at  once  comprehensive  and  eminently  prac-  subjects  never  before  published. — Charleston  Med. 
tical,  and  by  universal  consent  etands  at  the  head  of    Journal  and  Rtvietv. 

BY  THE  SAME  AUTHOR.     {New  Edition,  ju.$t  issited.) 

ON  POISONS,  IN  RELATION  TO   MEDICAL  J  URISPRUDENCE  AND 

MEDICINE.    Second  American,  from  a  second  and  revised  London  edition.     In  one  large 

octavo  volume,  ol  755  pages,  leather.     $3  50. 

Since  the  first  appearance  ol  this  work,  the  rapid  advance  of  Chemistry  has  introduced  into 
use  many  new  sub:stances  which  may  become  fatal  through  accident  or  design  —  while  at  the 
same  time  it  hav  likewise  designated  new  and  more  exact  modes  of  counteracting  or  delecting  those 
previously  treated  of.  Mr.  Taylor's  position  as  the  leading  medical  jurist  of  England,  has  during 
this  periocl  conferred  on  him  extraordinary  advantages  in  acquiring  experience  cii  these  subjects, 
nearly  all  cases  of  mor»ent  being  referred  to  him  for  examination,  as  an  expert  whose  testimony 
is  generally  accepted  as  final.  The  results  of  his  labors,  therefore,  as  gathered  together  in  this 
volume,  carefully  weighed  and  sifted,  and  presented  in  the  clear  and  inlelligible  style  for  which 
he  IS  noted,  may  be  received  a-s  an  acknowledged  authority,  and  as  a  guide  to  be  lollowed  with 
mpiicit  confidence. 


AND    SCIENTIFIC    PUBLICATIONS. 


20^ 


TODD  (ROBERT  BENTLEY),  M .  D.,  F.  R.  S., 

Professor  of  Physiology  in  King's  College,  London;  and 
WILLIAM  BOWMAN,  F.  R.  S., 

Demonstrator  of  Anatomy  in  King's  College,  London. 

THE  PHYSIOLOGICAL  ANATOMY  AND  PHYSIOLOGY  OF  MAN.    With 

about  three  hundred  large  and  beautiful  illustrations  on  wood.     Complete  in  one  large  octavo 

volume,  of  950  pages,  leather.     Price  $4  50. 

B^  Gentlemen  v*rho  have  received  portions  of  this  work,  as  published  in  the  "  Medical  News 
AND  Library,"  can  now  complete  their  copies,  if  immediate  application  be  made.  It  will  be  fur- 
nished as  follows,  free  by  mail,  in  paper  covers,  with  cloth  backs. 

Parts  I.,  II.,  III.  (pp.  25  to  552),  $2  50. 

Part  IV.  (pp.  553  to  end,  with  Title,  Preface,  Contents,  fee),  $2  00. 

Or,  Part  IV.,  Section  II.  (pp.  725  to  end,  with  Title,  Preface,  Contents,  &c.),  $1  25. 


A  magnificent  contribution  to  British  medicine, 
and  the  American  physician  who  shall  fail  to  peruse 
it,  wili  have  failed  to  read  one  of  the  most  instruc- 
tive books  of  the  nineleenlh  century. — N.  O.  Med 
and  Surg.  Journal,  Sept.  1857. 

It  is  more  concise  than  Carpenter's  Principles,  and 
more  modern  than  the  accessible  edition  of  Mailer's 
Elements;  its  details  are  brief,  but  sufficiett;  its 
descripl  ions  vivid  ;  its  illustrations  exact  and  copi- 
ous; and  its  language  terse  and  perspicuous. — 
Charleston  Med.  Journal,  July,  1S57. 

We  know  of  no  work  on  the  subject  of  physiology 


so  well  adapted  to  the  wants  of  the  medical  student. 
Its  completion  has  been  thus  long  delayed,  that  the 
authors  might  secure  accuracy  by  personal  observa- 
tion.— St.  Louis  Med.  and  Surg.  Journal,  Sept.  '57. 

Our  notice,  though  it  conveys  but  a  very  feeble 
and  imperfect  idea  of  the  magnitude  and  importance 
of  the  work  now  under  consideration,  already  tran- 
scends our  limits  ;  and,  with  the  indulgence  of  our 
readers,  and  the  hope  that  they  will  peruse  the  book 
for  themselves,  as  we  feel  we  can  with  confidence 
recommend  it,  we  leave  it  in  their  hands.  —  The 
Northwestern  Med.  and  Surg.  Journal. 


TODD  (R.   B.)     M.  D.,    F.  R.  S.,   &c. 
CLINICAL  LECTURES  ON  CERTAIN  DISEASES  OF  THE  URINARY 

ORGANS  AND  ON  DROPSIES.    In  one  octavo  volume,  284  pages.     $1  50. 
BY  THE  SAME  AUTHOR.      {Nov>  Ready.) 

CLINICAL  LECTURES  ON  CERTAIN  ACUTE  DISEASES.     In  one  neat 


octavo  volume,  of  320  pages,  extra  cloth. 


75. 


TOYNBEE  (JOSEPH),   F.  R.  S,, 

Aural  Surgeon  to,  and  Lecturer  on  Surgery  at,  St.  Mary's  Hospital. 

A  PRACTICAL  TREATISE  ON  DISEASES   OF   THE   EAR;   their  Diag- 

nosis,  Pathology,  and  Treatment.     Illustrated  with  one  hundred  engravings  on  wood.    In  one 

very  handsome  octavo  volume,  extra  clolh,  $3  00.     {Just  Issued.) 

The  work,  as  was  stated  at  the  outset  of  our  no-  |  ment,  and  with  a  sincere  and  unbiassed  judgment, 


tice,  is  a  model  of  its  kind,  and  every  page  and  para- 
graph ot  it  are  worthy  of  the  most  thorough  study. 
Considered  all  in  all — as  an  original  work,  well 
written,  philosophically  elaborated,  and  happily  il- 
lustrated with  cases  and  drawings — it  is  by  far  the 


when  we  affirm  Ihac  as  a  treatise  on  Aural  Surgery, 
it  is  without  a  rivi>l  in  our  language  or  any  otiier. — 
Charleston  Med.  Joiirii.  and  Keview,  Sept.  tSGO. 

The  work  of  Mr.  Toynbee  is  undoubtedly,  upon 
the  whole,  the  most  valuable  production  of  tiie  kind 


ablest   monograph    that  has  ever  appeared  on  the  i  ,„  ^ny  language.     The  author  has  long  Deen  known 
anatomy  and  diseases  of  the  ear,  and  one  of  the  most  !  (jy  jjjg  numerous  monographs  upon  subjects   con 


valuable  contributions  to  the  art  and  science  of  sur 
gery  in  the  nineteenth  century. — N.  Arner.  Medico- 
Chirurg  Review,  Sept.  186U. 

To  recommend  such  a  work,  even  after  the  mere 
hint  we  have  given  of  its  original  excellence  and 
value,  would  be  a  work  of  supererogation.  We  are 
speaking  within  the  limits  of  modest  acknovvledg- 


nected  with  diseases  of  the  ear,  and  is  now  regarded 
as  the  highest  authority  on  most  points  in  his  de- 
partment of  science.  Mr.  Toynbee's  work,  as  we 
have  already  said,  is  undoubtedly  the  most  reliable 
guide  for  the  study  of  the  diseases  of  the  tar  in  any 
language,  and  should  be  in  the  library  of  every  phy- 
sician.—6' /ticag^o  Med.  Journal,  Jul)  ,  WGU. 


WILLIAMS  (C.   J.   B.),    M.D.,    F.  R.  S., 

Professor  of  Clinical  Medicine  in  University  College,  London,  &c. 

PRINCIPLES  OP  MEDICINE.     An  Elementaiy  View  of  the  Causes,  Nature, 

Treatment,  Diagnosis,  and  Prognosis  of  Disease;  with  brief  remarks  on  Hygienics,  or  the  pre- 
servation of  health.  A  newAmerican,  from  the  third  and  revised  London  edition.  In  one  octavo 
volume,  leather,  ol  about  500  pages.     $2  50.     {Just  Issued.) 


We  find  that  the  deeply-interesting  matter  and 
style  of  this  book  have  so  far  fascinated  us,  that  we 
have  unconsciously  hung  upon  its  pages,  not  too 
long,  indeed,  for  our  own  profit,  but  longer  than  re- 
viewers can  be  permitted  to  indulge.  We  leave  the 
further  analysis  to  the  student  and  practitioner.  Our 
judgment  of  the  work  has  already  been  sufficiently 


expressed.    It  is  a  judgment  of  almost  unqualified 
praise. — London  Lancet, 

A  text-book  to  which  no  other  in  our  language  is 
comparable. — Charleston  Medical  Journal. 

No  work  has  ever  achieved  or  maintained  a  more 
deserved  reputation.— Va.  Med.  and  Surg.  Journal. 


WHAT   TO   OBSERVE 
AT    THE    BEDSIDE    AND    AFTER   DEATH,   IN    MEDICAL   CASES. 

Publishedundertheauthority  of  the  London  Society  for  Medical  Observation.    A  new  American, 

from  the  second  and  revised  Londoi.  edition.    In  one  very  handsome  volume,  royal  12mo.,  extra 

clolh.     $1  00. 

To  the  observer  who  prefers  accuracy  to  blunders  )      One  of  the  finest  aids  to  a  young  practitioner  wo 
aad  precision  to  carelessness,  this  little  book  is  ;n- 
Taiuable.— iV.  H.  Journal  of  Medicin*. 


have  ever  a€,ea.—Ptnins\ilaT  Journal  of  Mtditin*. 


30 


BLANCHARD    &    LEA'S    MEDICAL 


New  and  much  enlarged  edition — (Just  Issued.) 

WATSON   (THOMAS),    M.D.,    &.C., 

Late  Physician  to  tlie  Middlesex  Hospital,  &c. 

LECTURES    ON    THE    PRINCIPLES    AND    PRACTICE   OP   PHYSIC. 

Delivered  at  King's  Colleffe,  London.     A  new  American,  from  the  last  revised  and  enlarged 

English  edition,  with  Additions,  by  D.  Francis  Condie,  M.D.,  author  of  "A  Practical  Treatise 

on  the  Diseases  of  Children,"  i:c.     Wilh  one  hundred  and  eighty.five  illustrations  on  wood.     In 

one  very  large  and  hand>ome  volume,  imperial  octavo,  of  over  1200  closely  printed  pages  in 

small  type  ;  the  whole  strongly  bound  in  leather,  with  raided  bands.     Price  $4  25. 

That  the  high  reputation  of  this  work  might  be  fully  maintained,  the  author  has  subjected  it  to  a 

thorough  revision;  every  portion  has  been  examined  wilh  the  aid  of  the  most  recent  researches 

in  pathology,  and  the  results  of  modern  investigations  in  both  theoretical  and  practical  subjects 

have  been  carefully  weighed  and  embodied  throughout  its  pages.     The  watchful  scrutiny  of  the 

editor  has  likewise  introduced  whatever  possesses  immediate  importance  to  the  American  physician 

in  relation  to  diseases  incident  to  our  climate  which  are  little  known  in  England,  as  well  as  those 

points  in  which  experience  here  has  led  to  different  modes  of  practice  ;  and  he  has  also  added  largely 

to  the  series  of  illustrations,  believing  that  in  this  manner  valuable  assistance  may  be  conveyed  lo 

the  student  in  elucidating  the  text.     The  work  will,  therefore,  be  found  thoroughly  on  a  level  with 

the  most  advanced  state  of  medical  science  on  both  sides  of  the  Atlantic. 

The  additions  which  the  work  has  received  are  shown  by  the  tact  that  notwithstanding  an  en- 
largement in  the  size  of  the  page,  more  than  two  hundred  additional  pages  have  been  necessary 
to  accommodate  the  two  large  volumes  of  the  London  edition  (which  sells  at  ten  dollars),  within 
the  compass  of  a  single  volume,  and  in  its  present  form  it  contains  the  matter  of  at  least  three 
ordinary  octavos.  Believing  it  to  be  a  work  which  should  lie  on  the  table  of  every  physician,  and 
be  in  the  hands  of  every  student,  the  publishers  have  put  it  at  a  price  within  the  reach  of  all,  making 
it  one  of  the  cheapest  books  as  yet  presented  to  the  American  profession,  while  at  the  same  time 
the  beauty  of  its  mechanical  execution  renders  it  an  exceedingly  attractive  volume. 

The  fourth  edition  now  appears,  so  carefully  re-  1  The  lecturer's  skill,  his  wisdom,  his  learning, are 
vised,  as  to  add  considerably  to  the  value  of  a  book  equalled  by  the  ease  of  his  graceful  diction,  his  elo- 
already  acknowledged,  wherever  the  English  Ian-  quence,  and  the  far  higher  qualities  of  candor,  of 
guage  is  read,  to  be  beyond  all  eomparisdn  the  best  courtesyj  of  modesty,  and  of  generous  appreciation 
systematic  work  on  the  Principles  and  Practice  of  ^  of  merit  \n  others.  Alay  he  long  remain  to  instruct 
Physic  in  the  whole  range  of  medical  literature.  |  us,  and  to  enjoy,  in  the  glorious  sunset  of  his  de- 
Every  lecture  contains  proof  of  the  extreme  anxiety  I  dining  years,  the  honors,  the  confidence  and  love 
of  the  author  to  keep  pace  with  ihe  advancing  know-  gained  during  his  useful  life.— iV.  A.  Med.-Chir. 
ledge  of  the  day,  and  to  bring  the  results  of  the  Review. 
labors,  not  only  of  physicians,  but  of  chemists  and 


histologists,  before  his  readers,  wherever  they  can 
be  turned  to  useful  account.  And  this  is  done  wilh 
Buch  a  cordial  appreciation  of  the  merit  due  to  the 
industrious  observer,  such  a  generous  desire  to  en- 
courage younger  and  rising  men,  and  such  a  candid 
acknowledgment  of  his  own  obligations  to  them, 
that  one  scarcely  knows  whether  to  admire  most  the 
pure,  simple,  forcible  English — the  vast  amount  of 
uset'ul  practical  information  condensed  into  the 
Lectures— or  the  manly,  kind-hearted,  unassuming 
character  of  Ihe  lecturer  shining  through  his  work. 
— London  Med.  Times  and  Gazette. 

Thus  these  admirable  volumes  come  before  the 
profession  in  their  fourth  edition,  abounding  in  those  I  third  edition,  which  has  been  severely  I'elt  for  the 


Watson's  unrivalled,  perhaps  unapproachable 
work  on  Practice — the  copious  additions  made  to 
^vhich  (the  fourth  edition)  have  given  it  all  the  no- 
velty and  much  of  the  interest  of  a  new  book. — 
Charleston  Med.  Journal. 

Lecturers,  practitioners,  and  students  of  medicine 
will  equally  iiail  the  reappearance  of  the  work  of 
Dr.  Watson  in  the  form  of  a  new — a  fourth — edition. 
We  merely  do  justice  to  our  own  feelings,  and,  we 
are  sure,  of  the  whole  profession,  if  we  tliank  him 
for  having,  in  the  trouble  and  turmoil  of  a  large 
practice,  made  leisure  to  supply  the  hialus  caused 
by  the  exhaustion  of  the  publisher's   stock  of  the 


distinguished  attributes   of  moderation,  judgment, 

erudite  cultivation,  clearness,  and  eloquence,  with 

Which  they  were  from  the  first  invested,  but  yet 

richer  than  bel"ore  in  the  results  of  more  prolonged 

observation,  and    in   the  able  appreciati(m   of  the 

latest  advances  in  pathology  and  medicine  by  one 

of  the  most  proi'ound  medical  thinkers  of  the  day. —  j  Medico-Chi.r.  Heview. 

London  Lancet.  \ 


last  three  years.  For  Dr.  Watson  has  not  merely 
caused  the  lectures  to  be  reprinted,  but  scattered 
through  the  whole  work  wc  find  additions  or  altera- 
tions which  prove  that  the  author  has  in  every  way 
sought  to  bring  up  his  teaching  to  the  level  of  the 
most  recent  acquisitions  in  science. — Brit,  and  For. 


WALSHE  (W.   H.),   M.  D., 

Professor  of  the  Principles  and  Practice  of  Medicine  in  University  College,  London,  &;c. 

A  PRACTICAL  TREATISE  ON  DISEASES  OF  THE  LUNGS;  including 

the  Principles  of  Physical  Diagnosis.    A  new  American,  from  the  third  revised  and  much  en- 
larged Lone  on  edition.     In  one  vol.  octavo,  of  4b8  pages.     (Just  Issued,  June,  18Q^.)     §2  "25. 

The  present  edition  has  been  carefully  revised  and  much  enlarged,  and  may  be  said  in  the  main 
to  be  rewritten.  Descriptions  of  several  diseases,  previously  omitted,  are  now  introduced;  the 
causes  and  mode  of  production  of  Ibe  more  important  alfectioiis,  so  far  as  they  possess  direct  prac- 
tical significance,  are  succinctly  inquired  into;  an  effort  has  been  made  to  bring  the  description  ol 
anatomical  characters  to  the  level  of  the  wants  of  the  practical  physician  ;  and  the  diagnosis  and 
prognosis  of  each  complaint  are  more  completely  considered.  The  sections  on  Treat.me.\t  and 
the  Appendix  (concerning  the  inlluence  of  climate  on  pulmonary  disorders),  have,  eepeciully,  been 
largely  extended. — Aiithor''s  Preface. 

^*^  To  be  followed  by  a  similar  volume  on  Diseases  of  the  Heart  and  Aorta. 


WILSON  (ERASMUS),   F.  R.  S., 

Lecturer  on  Anatomy,  London. 

THE    DISSECTOR'S  MANUAL;  or,  Practical  and  Surgical  Anatomy.     Third 

American,  from  the  last  revised  and  enlarged  English  edition.  Modified  and  rearranged,  by 
William  Hunt,  M.  D.,  Demonstrator  of  Anatomy  in  the  University  ol  Pennsylvania.  In  one 
large  and  handsome  royal  12mo.  volume,  leather,  of  582  pages,  with  154  illustrations.    $2  00. 


AND    SCIENTIFIC    PUBLICATIONS. 


3r 


New  and  much  enlarged  edition— (Just  Issued.) 
WILSON    (ERASMUS),  F.  R.  S. 

A  SYSTEM  OF  HUMAN  ANATOMY,  General  and  Special.     A  new  and  re- 
vised American, from  the  last  and  enlarged  Engli.-h  Edition.    Edited  by  W.  H  Gobrecht  M  D 
Profe>sor  of  Anatomy  in  the  Pennsylvania  Medical  College,  &c.     Illustrated  with  three  hundred 
and  ninety-seven  engravmgs  on  wood.     In  one  large  and  exquisitely  printed  octavo  volume  of 
over  600  large  pages;  leatiier.     $3  25.  ' 

The  publishers  trust  that  the  well  earned  reputation  so  long  enjoyed  by  this  work  will  be  more 
than  maintained  by  the  present  edition.  Besides  a  very  thorough  revision  by  the  author  it  ha^been 
most  carefully  exammed  by  the  editor,  and  the  efforts  of  both  have  been  directed  to  introducino- 
everything  which  increa'^ed  experience  in  its  use  has  suggested  as  desirable  to  render  it  a  complete 
text-book  for  those  seeking  to  obtain  or  to  renew  an  acquaintance  with  Human  Anatomy.  The 
amount  of  additions  which  it  has  thus  received  may  be  estimated  .("rom  the  fact  that  the  present 
edition  contains  over  one-fourth  more  matter  than  the  last,  rendering  a  smaller  type  and  an  enlar°-ed 
page  requisite  to  keep  the  volume  within  a  convenient  size.  The  author  has  not  only  thus  added 
largely  to  the  work,  but  he  has  also  made  alterations  throughout,  wherever  there  appeared  the 
opportunity  of  improving  the  arrangement  or  style,  so  as  to  present  every  fact  in  its  most  appro- 
priate manner,  and  to  render  the  whole  as  clear  and  intelligible  as  possible.  The  editor  has 
exercised  the  utmost  caution  to  obtain  entire  accuracy  in  the  text,  and  has  Largely  increased  the 
number  of  illustrations,  of  which  there  are  about  one  hundred  and  fifty  more  in  this  edition  than 
in  the  last,  thus  bringing  distinctly  before  the  eye  of  the  student  everything  of  interest  or  importance. 


It  may  be  recommended  to  the  student  as  no  less 
distinguished  by  its  accuracy  and  clearness  of  de- 
scription th;m  by  its  typographical  elegance.  The 
wooii-cuts  are  exquisite. — Brit,  and  For.  Medical 
Review. 

An  elegant  edition  of  one  of  the  most  useful  and 
accurate  systems  of  anatomicat  science  which  has 
been  issued  from  the  press  The  illustrations  are 
really  beautiful.  In  its  style  the  \v()rk  is  extremely 
concise  and  intelligible.  No  one  can  possibly  take 
up  this  volume  without  being  struck  with  the  great 

BY  THE  SAME  AUTHOR. 


beauty  of  its  mechanical  execution,  and  the  clear- 
ness of  the  descriptions  which  it  contains  is  equally 
evident.  Let  students,  by  all  means  examine  tiie 
claims  of  this  work  on  their  notice,  before  they  pur- 
chase a  text-book  of  the  vitally  impcirtant  science 

which  this  volume  &o  fully  and  easily  unfolds. 

Lancet. 

We  regard  it  as  the  best  system  now  extant  for 
students. — Wester7i  Lancet. 

It  therefore  receives  our  highest  commendation. 

Southern  Med.  and  Surg.  Journal. 


{Just  Issued.) 

ON  DISEASES  OF  THE  SKIN.     Fourth  and  enlarged  American,  from  the  last 

and  improved  London  edition.     In  one  large  octavo  volume,  of  650  pages,  extra  cloth,  $2  75. 

The  writings  of  Wilson,  upondiseases  of  the  skin, 
are  by  far  the  most  scientifie  and  practical  that 
have  ever  been  presented  to  the  medical  world  on 
this  subject.    Thepresentedition  isa  great  improve 


inent  on  all  its  predecessors.  To  dwell  upon  all  the 
great  merits  and  high  claims  of  the  work  before  us, 
seriatim,  would  indeed  be  an  agreeable  service  ;  it 
v/ould  be  a  mental  homage  which  we  could  freely 
offer,  but  we  should  thus  occupy  an  undue  amount 
of  space  in  this  Journal.    We  will,  howtver,  look 


at  some  of  the  more  salient  points  with  which  it 
abounds, and  wh ich  make  ii incoinpurH uiy  su perior  in 
excellence  to  all  other  treatises  on  thesubject  of  der- 
matology. No  mere  speculative  views  are  allowed 
a  place  in  this  volume,  which,  without  a  doubt,  will, 
for  a  very  long  period,  be  acknowledged  as  the  chief 
standard  work  on  deiinatohigy.  The  principles  of 
an  enlightened  and  rational  therapeia  are  introduced 
on  every  appropriate  occasion. — Am.  Jour.  Med. 
Science,  Oct.  1857. 


ALSO,  NOW  READY, 

A  SERIES  OF  PLATES  ILLUSTRATING  WILSON  ON  DISEASES  OP 

THE  SKIN  ;  consisting  of  nineteen  beautifully  executed  plates,  of  which  twelve  are  exquisitely 
colored,  presenting  the  Normal  Anatomy  and  Pathology  of'  the  Skin,  and  containing  accurate  re- 
presentations of  about  one  hundred  varieties  of  disease,  most  of  them  the  size  of  nature.  Price 
in  cloth  $4  25. 

In  beauty  of  drawing  and  accuracy  and  finish  of  coloring  these  plates  will  be  found  equal  to 
anything  of  the  kind  as  yet  issued  in  this  country. 


The  plates  by  which  this  edition  is  accompanied 
leave  nothing  to  be  desired,  so  far  as  excellence  of 
delineation  and  perfect  accuracy  of  illustration  are 
concerned. —  Medico-C hirurgical  Review. 

Of  these  plates  it  is  impossible  to  speak  toohighl}'. 
The  representations  of  the  various  forms  of  cutane- 
Dus  disease  are  singularly  accurate,  and  the  color- 
ing exceeds  almost  anything  we  have  met  with  in 
point  of  delicacy  and  &ms,h.— British  and  Foreign 
Medical  Review. 


We  have  already  expressed  our  high  appreciation 
of  Mr.  Wilson's  treatise  on  Diseases  of  the  Skin. 
The  plates  are  comprised  in  a  separate  volume, 
which  we  counsel  all  those  who  possess  the  text  to 
purchase.  It  is  a  beautiful  specimen  of  color  print- 
ing, and  the  representations  of  the  various  forms  of 
skin  disease  are  as  faithful  as  is  possible  in  plates 
of  the  size. — Boston  Med.  and  Surg.  Journal,  April 
8,  1858. 


BY  THE  SAME  AUTHOR. 

ON    CONSTITUTIONAL    AND    HEREDITARY    SYPHILIS,  AND    ON 

SYPHILITIC  ERUPTIONS.    In  one  small  octavo  volume,  extra  cloth,  beautifully  printed,  with 
four  exquisite  colored  plates,  presenting  more  than  thirty  varieties  of  syphilitic  eruptions.  $2  25, 

BY   THE  SAME   AUTHOR. 

HEALTHY  SKIN;  A  Popular  Treatise  on  the  Skin  and  Hair,  their  Preserva- 
tion and  Management.  Second  American,  from  the  fourth  London  edition.  One  neat  volume, 
royal  12mo.5  extra  cloth,  of  about  300  pages,  with  numerous  illustrations.  $1  00  ;  paper  cover, 
75  cents. 


WHITEHEAD  ON  THE  CAUSES  AND  TREAT- 
MENT OF    AliORTION    AND  STERILITY. 


Second  American  Edition.    In  one  volume,  octa- 
vo extra  cloth,  pp.  308.    51    75. 


BLANCHARD    &    LEA'S    MEDICAL    PUBLICATIONS. 


WINSLOW    (FORBES),  M.D.,    D.  C.  L.,   &.c. 
ON  OBSCURE  DISEASES  OF  THE  BRATN  AND  DISORDERS  OF  THE 


MIND;  their  incipient  Symptom-^,  Pal holugy, 
handsome  octavo  volume,  of  nearly  600  pages 
We  close  this  brief  and  necessarily  very  imperfect 
notice  (if  Dr.  Wmslow's  j  real  and  classieal  work, 
by  expressing  our  conviction  that  it  is  long  since  so 
important  and  beautifully  written  a  volume  liiis  is- 
sued from  the  British  medical  pre^s.—JJvblin Med. 
rress,  July  25,  ISGU. 

We  honestly  believe  this  to  b"  the  best  book  of  the 
eeviSot.—Ranhitig^i  Abstract,  July,  1^60. 

It  cairiedusback  to  our  old  days  of  novel  reading, 
it  kept  us  from  cur  dirncr,  from  our  bni-iness,  ■ind 
from  our  »luml)ers;  in  short,  we  luid  it  down  only 
when  we  had  got  to  the  end  of  the  last  paragmph, 
and  cvn  then  turned  bacK  to  the  repe  usal  ol  several 
passages  which  we  h  id  inarkrd  as  rtqiiiring  fur  her 
study  We  hnve  fuiKd  entirely  in  tlie  above  notice 
to  give  an  adequate  sicknowledginent  of  the  profit 
and  pleiisure  witn  which  a'c  liav-e  pcrufced  the  above 
WorK.     We  can  only  say  to  our  readers,  study  it 


Diagnosis,  Trealmeni,  and  Prophylaxis.     In  one 
{Just  Issued.)     $3  00. 

yourselves;  and  we  extend  the  invitation  to  unpro- 
fessional as  well  as  professional  men,  believing  that 
it  contains  matter  deeply  interesting  not  to  physi- 
cians alone,  but  to  all  who  appreciate  the  trutii  that; 
"  The  proper  siudy  of  mnnkind  is  man." — Nashville 
Mfdical  Record,  July.  1^60. 

The  latter  portion  of  Dr.  Winslow's  work  is  ex- 
clusively deviited  to  the  consideration  of  Cerebral 
PatholoKy.  It  completely  exhausts  the  subject,  in 
the  s  irae  manner  as  the  previous  seventeen  chapters 
relating  to  morbid  psy.;hical  phenomena  lelt  nothing 
unnoticed  in  refereiice  to  ihe  menial  symptoms  pre- 
monitory of  Cerebral  diseaie  It  is  impossible  to 
overrate  the  benefits  likely  to  result  from  a  general 
perusal  of  Dr.  Winslow's  valuajle  and  deeply  in- 
teresting work  — London  Lancet,  June  23,  If-GO. 

It  contains  an  immense  mafs  of  information. — 
Brit,  anil  For.  Mtd.-Ch.ir.  Review,  Oct.  ItOO, 


WEST   (CHARLES),    M.  D., 

Accoucheur  to  and  Lecturer  on  Midwifery  at  St.  Bartholomew's  Hospital,  Physician  to  the  Hospital  for 

Sick  Children,  dec. 

LECTURES  ON  THE  DISEASES  OF  WOMEN.    Second  American,  from  the 

second   London   edition.     In   one   liaiid<onie  octavo  volume,  extra  cloth,  ol  about  500  pages; 

price  iiji".^  50.     (Now  Ready,  July,  lb6l.) 
*,t*  Gentlemen  who  received  the  first  portion,  as  issued  in  the  "Medical  News  and  Library,"  can 

now  compete  their  copies  by  procuring  Part  II,  being  page  309  to  end,  with  Index,  Title  matter, 

&c.,  8vo.,  cloth,  price  $1. 

proverb,  along  a  royal  road  to  learning.  His  work 
IS  one  whicii  will  not  satisfy  the  extreme  on  either 
Bide,  but  It  is  one  thai  will  please  the  great  mujuriiy 
who  arc  seeking  Irulh  and  one  Ihat  will  convince 
the  student  Ihat  he  has  commuted  hiiiiselt  to  a  can- 
did, bfiie,  and  valuable  guide.  W k  anticipate  with 
pleasure  tlie  appeiirance  of  the  sectmd  part  of  the 
work,  which,  if  it  tquals  this  part,  will  complete 
one  ol  our  very  best  volumes  upon  iliseases  of  fe- 
males — iV.  A.  Med  -Ckirurg.  Review,  July,  1^5ti. 

Happy  in  his  simplicity  of  manner,  und  moderate 
in  hig  expression  of  opinion,  the  author  is  a  sound 
reasoner  and  a  good  piuctitioner,  and  his  hook  is 
worthy  <il  the  hanusome  ga'b  in  whicli  it  has  ap- 
peared from  the  press  of  the  Philadelphia  publishers. 
—  Virginia  Med.  Journal. 

We  must  take  leave  of  Dr.  West's  very  useful 
work,  Willi  our  cominenduiKm  ot  tlie  eleurness  of 
its  style,  and  the  uu  ustry  and  sobriety  of  judgment 
of  whicii  II  gives  evidence. — London  Med  Times 
and  Uazetle. 


We  must  now  conclude  this  hastily  written  sketch 
with  the  confident  assurance  to  our  rcadeis  that  the 
work  will  well  repay  perusal.  The  conscientious, 
painstaking,  prac'ical  phytician  isapparent  on  everj 
page. — A'.  Y.  Journal  of  Medicine,  March,  ls5S. 

We  know  of  no  treatise  of  the  kind  so  complete 
an'l  yet  so  compact.— CAtcago  Med.  Journal,  Janu- 
ary, 1»58. 

A  fairer,  more  honest,  more  earnest,  and  more  re- 
liable investigator  of  the  many  diseases  of  women 
and  chilcren  is  not  to  be  found  in  any  country.— 
Southern  Med.  and  Surg.  Journal,  January  IHoS. 

We  gladly  recommend  his  Lectures  us  in  the  high- 
est degree  instructive  to  all  who  are  interested  in 
obstetric  practice. — London  Lancet. 

We  have  to  say  of  it,  briefly  and  decidedly,  that 
it  is  the  best  work  on  the  subject  in  any  language; 
and  that  it  stamps  Dr.  West  as  tlie/ac(7e  princept 
of  British  obstetric  authors. — Edinb.  Med.  Journ. 

As  a  writer,  Dr.  West  stands,  in  our  opinion,  sec- 
ond only  to  Watson,  the  "  Macaulay  of  .Medicine;" 
he  possesses  tiiat  happy  faculty  of  clothing  instruc 


Sound  judgment  and  good  sense  pervade  every 
tion  in  easy  garments';  CJinbining  pleasure  with  |  chapLer  oi  the  uin.k.  From  its  perusal  we  liave  de- 
profil,  he  leads  his  pupils,  lu  siuie  of  the  ancient. I  rived  unmixed  latist'action. — JJubiin  Quart.  Juurn. 

BY  THE  SAME  AUTHOR.     (Just  Issued.) 

LECTURES   ON   THE   DISEASES    OF  INFANCY  AND  CHILDHOOD. 


Third  American,  from  the  fourth  enlarged  and  improved  London  edition 
octavo  volume,  extra  cloth,  ol'  about  six  hundred  and  lil'ty  pages.     $•?  75. 
The  three  former  editions  of  the  work  now  before 

us  have  placed  tlie  author  in  tne  loremost  ruuk  cf 

those  ph>  sicians  who  have  cevoted  special  attention 

to  tne  uiseabes  of  early  life      We  attempt  no  ana- 

1)  SIS  of  tills  editiiin,  but  may  refer  the  reader  to  some 

of  the  ciiaplers  to  wnich  the  largest  aduitions  have 

been  made — those  un  Diphtheria,  Disorderj  of  the 


In  one  handsome 


diseases  it  omits  to  notice  altogether.  But  those 
who  know  anything  of  the  present  condition  of 
ptediairics  win  readily  admit  Uiat  it  would  lie  next 
to  impiissiole  to  elfect  more,  or  elfect  it  better,  tiian 
ibe  accoucheur  of  St.  Bartholomew's  has  done  in  a 
single  voiume.  The  lecture  (XVI.)  upon  Disorcirs 
f  the  .Miiid  in  chiloren  is  an  admirable  specimen  of 


Mind,  and  Idiocy,  for  instance — as  a  prooi   that  Ihe     the  value  oi  the  later  information  ctmvejed  in  the 


work  IS  really  a  new  edition;  not  a  mere  repriut. 
In  its  prei  ent  shape  it  will  be  lound  of  ihe  greatest 
possible  service  in  the  evcry-day  practice  ol  nine- 
tenlhs  of  the  profession. — Med.  Times  and  Gazette, 
London,  Dec.  lU,  18j9. 

All  things  consid;  red  this  book  of  Dr.  West  is 
by  far  the  best  treatise  in  our  language  upon  such 
modifi jatiuns  of  morbid  action  and  diseise  as  are 
witntbsed  when  we  have  to  deal  with  infancy  and 
childhood.  It  IS  true  that  it  confines  itself  to  such 
disorders  as  come  wi-hin  the  province  of  the  phy- 
sician, and  even  with  res^ject  to  tnese  it  is  unequal 
as  regards  minuteness  of  consideration,  and  some 


Lectures   of  iir.    Charles   West. — London  Lancet, 
Oct.  22,  IS59. 

Since  the  appearance  of  the  first  edition,  about 
eleven  years  ago,  the  experience  of  the  author  has 
Uoubbd;  so  that,  whereas  the  leclures  at  lii  st  were 
founded  on  six  hundred  observations,  and  one  hun- 
dred and  eigiiiy  dissections  made  among  neaily  four- 
teen thousand  children,  they  now  embody  the  results 
of  nine  hundred  observations,  and  two  liundr'-d  and 
eighty-eight  post- iiiorlem  examinations  male  among 
nearly  thirty  thousand  children,  who,  durii.g  the 
past  twiily  years,  have  been  under  his  care. — 
British  Med.  Journal,  Oct.  1,  18oU. 


BY  THE  SAME  AtJTHOR. 

AN  ENQUIRY  INTO  THE  PATHOLOGICAL  IMPORTANCE  OF  ULCER- 

ATION  UF  THE  OS  UTERI.    la  one  neat  octavo  volume,  extra  cloth,     fl  00. 


I 


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Los  Angeles 
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